Provider
Sodium-glucose Co-transporter (SGLT) Inhibitors and Combinations - Medicaid
Step Therapy, Quantity Limit
Program effective Date: Apr 01, 2025
Step Therapy, Quantity Limit
Program effective Date: Apr 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: Aug 01, 2025
Step Therapy
Program effective Date: Jul 01, 2025
Step Therapy, Quantity Limit
Program effective Date: Apr 01, 2025
Prior Authorization
Program effective Date: Feb 01, 2025
Prior Authorization, Quantity Limit
Program effective Date: May 01, 2025
Program effective Date: Mar 23, 2022
Program effective Date: Mar 01, 2022
Program effective Date: Mar 01, 2022