Non-Group Coverage (Group 1) Coverage for Seniors (Group 66) Palliative Coverage (Group 20514, Please note your client may have Group 1 or Group 66 coverage) Child and Family Services (Group 20403) Alberta Child Health Benefit (Group 20400) Children and Youth Services (Group 19824) Income Support (Group 19823) Alberta Human Services (AISH) (Group 19823) Alberta Adult Health Benefit (AAHB) (Group 23609)
The drug product(s) listed below are eligible for coverage via the step therapy/special authorization process.
FIRST-LINE DRUG PRODUCT(S): METFORMIN SECOND-LINE DRUG PRODUCT(S): SULFONYLUREAS AND WHERE INSULIN IS NOT AN OPTION
As add-on therapy for the treatment of Type 2 diabetes in patients with intolerance to and/or inadequate glycemic control on: - a sufficient trial (i.e. a minimum of 6 months) of metformin, AND - a sulfonylurea, AND - for whom insulin is not an option.
Or, for whom these products are contraindicated.
Special authorization may be granted for 24 months.
Note: If a claim for the Step therapy drug product is rejected, pharmacists can use their professional judgment to determine the appropriateness of using the intervention code(s) noted below to re-submit a claim. The pharmacist is responsible to document on the patient's record the rationale for using the second-line therapy drug.
UP - First-line therapy ineffective UQ - First-line therapy not tolerated CA - Prior adverse reaction CB - Previous treatment failure CJ - Product is not effective
All requests for sitagliptin+metformin must be completed using the DPP-4/SGLT2 Inhibitors/GLP-1 Receptor Agonist Special Authorization Request Form (ABC 60012).
Review Status / Past Decisions
Indication
Reviewing Body
Submission Completion Date
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
Review Status
N/A
Expert Committee
2016/06/08
2016/09/01
Under Review
N/A
Expert Committee
2016/06/08
2017/04/01
Step Therapy/Special Authorization
N/A
Expert Committee
2015/12/10
2016/03/01
Not a Benefit
Indication
N/A
Reviewing Body
Expert Committee
Submission Completion Date
2016/06/08
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2016/09/01
CDR Recommendation
Review Status
Under Review
Indication
N/A
Reviewing Body
Expert Committee
Submission Completion Date
2016/06/08
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2017/04/01
CDR Recommendation
Review Status
Step Therapy/Special Authorization
Indication
N/A
Reviewing Body
Expert Committee
Submission Completion Date
2015/12/10
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2016/03/01
CDR Recommendation
Review Status
Not a Benefit
MERCK CANADA INC. (MFC)
Telephone:(514) 428-7920
Toll-Free:(800) 361-7031
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NOTICE:
The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.