PTC 682005

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Products Found: 24

MFR

Review Status/
Past Decision(s)

02417197
ALOGLIPTIN BENZOATE
NESINA
12.5 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02417200
ALOGLIPTIN BENZOATE
NESINA
25 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02417189
ALOGLIPTIN BENZOATE
NESINA
6.25 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02417235
ALOGLIPTIN BENZOATE/ METFORMIN HCL
KAZANO
12.5 MG * 1,000 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02417219
ALOGLIPTIN BENZOATE/ METFORMIN HCL
KAZANO
12.5 MG * 500 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02417227
ALOGLIPTIN BENZOATE/ METFORMIN HCL
KAZANO
12.5 MG * 850 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

LINAGLIPTIN
TRAJENTA
5 MG
ORL  TAB
2.6571
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

LINAGLIPTIN/ METFORMIN HCL
JENTADUETO
2.5 MG * 1,000 MG
ORL  TAB
1.3897
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

LINAGLIPTIN/ METFORMIN HCL
JENTADUETO
2.5 MG * 500 MG
ORL  TAB
1.3897
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

LINAGLIPTIN/ METFORMIN HCL
JENTADUETO
2.5 MG * 850 MG
ORL  TAB
1.3897
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SAXAGLIPTIN HCL
ONGLYZA
2.5 MG
ORL  TAB
2.4910
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SAXAGLIPTIN HCL
ONGLYZA
5 MG
ORL  TAB
2.9540
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SAXAGLIPTIN HCL/ METFORMIN HCL
KOMBOGLYZE
2.5 MG * 1,000 MG
ORL  TAB
1.2700
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SAXAGLIPTIN HCL/ METFORMIN HCL
KOMBOGLYZE
2.5 MG * 500 MG
ORL  TAB
1.2700
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SAXAGLIPTIN HCL/ METFORMIN HCL
KOMBOGLYZE
2.5 MG * 850 MG
ORL  TAB
1.2700
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE
JANUVIA
100 MG
ORL  TAB
3.0801
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE
JANUVIA
25 MG
ORL  TAB
3.0801
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE
JANUVIA
50 MG
ORL  TAB
3.0801
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET XR
100 MG * 1,000 MG
ORL  ERT
3.3155
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET
50 MG * 1,000 MG
ORL  TAB
1.6691
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET XR
50 MG * 1,000 MG
ORL  ERT
1.6577
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET
50 MG * 500 MG
ORL  TAB
1.6691
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET XR
50 MG * 500 MG
ORL  ERT
1.6577
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION

SITAGLIPTIN PHOSPHATE MONOHYDRATE/ METFORMIN HCL
JANUMET
50 MG * 850 MG
ORL  TAB
1.6691
N/A
TAB
NO

STEP THERAPY/ SPECIAL AUTHORIZATION


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