Diabetes Medication (Dipeptidyl peptidase – 4 [DPP-4] inhibitors) Step Therapy Program
As of May 1, 2013, State Health Plan members who wish to remain on the diabetes medications, Tradjenta®, Jentadueto®, Nesina®, or Kazano®, will be required to have a coverage review. These non-preferred medications will be subject to step therapy. If you fill or refill a prescription for these medications and do not first obtain the State Health Plan's approval, you will have to pay the full cost of the medication instead of just the copay.
Similar diabetes medications (Dipeptidyl peptidase – 4 [DPP-4] inhibitors) Januvia®, Janumet®, Janumet® XR, Onglyza® and Kobiglyze® XR will continue to be covered without a coverage review. Members will pay only the preferred copay of $40 per 30-day supply when filling these prescriptions.
| Preferred Medications |
Non-Preferred Medications |
| Januvia (sitagliptin) |
Tradjenta (linagliptin) |
| Janumet, Janumet XR (sitagliptin/metformin) |
Jentadueto (linagliptin/metformin) |
| Onglyza (saxagliptin) |
Nesina (alogliptin) |
| Kobiglyze XR (saxagliptin/metformin) |
Kazano (alogliptin/metformin) |
The step therapy program will ensure the use of State Health Plan preferred products, prior to the use of other non-preferred agents. Members must have tried a preferred agent first.
If you're taking one of the non-preferred medications listed and do not want to pay the full cost, here are some options:
- Talk to your provider and ask whether one of the preferred medications may be appropriate for you.
- Ask your provider to consider changing your prescription to one that doesn't require a review and will save you money.
- If your provider believes that there are special reasons you should continue using your current medication, he or she can request a coverage review by calling 800-417-1764, 8 a.m. to 9 p.m., Eastern time, Monday through Friday. If coverage is approved, you will pay the non-preferred copay of $64.
If you have any questions, please call Customer Services at 800-336-5933 or visit Express-Scripts.com.
