GLYXAMBI 25/5 mg Tablet, Film Coated
Also known as Empagliflozin And Linagliptin. Coverage in Alabama and Tennessee (CMS PDP Region 12).
6 of 12 stand-alone Part D plans in Alabama and Tennessee cover this drug on tier 3–4.
6 of 6 plans apply a prior authorization, step therapy or quantity limit.
174 Medicare Advantage plans in AL, TN do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. AL: 72 plans · TN: 102 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Value Script (PDP)$3.60/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $10.7860 | $32.363 units |
|
| Wellcare Classic (PDP)$3.70/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 25% | $10.7860 | $32.363 units |
|
| SilverScript Choice (PDP)$97.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $11.4834 | $34.453 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$119.30/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $11.9709 | $35.913 units |
|
| BlueRx Essential (PDP)$76.20/mo premium · $615.00 deductible | 4Non-Preferred Drug | 41% | 41% | $11.9473 | $35.843 units |
|
| BlueRx Enhanced Plus (PDP)$129.50/mo premium · $150.00 deductible | 4Non-Preferred Drug | 42% | 42% | $11.9473 | $35.843 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.