Does Gateway Health Plan, INC. require prior authorization for Trijardy?
Gateway Health Plan, INC. requires prior authorization for Trijardy on every Medicare Part D plan of theirs that covers it.
Every plan from this payer that covers the drug requires authorization before it is dispensed.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| 24 HR empagliflozin 10 MG / linagliptin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy]2359285 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| 24 HR empagliflozin 12.5 MG / linagliptin 2.5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy]2359290 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| 24 HR empagliflozin 25 MG / linagliptin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy]2359353 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
| 24 HR empagliflozin 5 MG / linagliptin 2.5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy]2359358 | 4 / 4 | 4 | 0 | 4 | Prior authorization required |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — 24 HR empagliflozin 10 MG / linagliptin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy]
Trijardy has 4 products in the corpus; this table is for 24 HR empagliflozin 10 MG / linagliptin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Trijardy], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | H5932-001 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | H5932-012 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | H5932-009 | 1 | Yes | No | Yes |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | H5932-013 | 1 | Yes | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
We publish the hash of the exact file we ingested so any answer can be audited against the bytes CMS served that day.
Trijardy at other payers
Administrative information only. Benefily reports what a payer has published in its own prior-authorization policy as of the effective date shown. It is not medical advice, not a coverage or payment guarantee, and not an authorization. Requirements vary by plan, place of service and member benefits — always verify with the payer before rendering service.