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No prior authorization

Does Mass General Brigham Health Plan, INC require prior authorization for Xigduo?

Mass General Brigham Health Plan, INC does not require prior authorization for Xigduo on the Medicare Part D plans that cover it.

No covering plan from this payer files a prior-authorization requirement for this drug.

  • This drug does not appear on any of this payer's Medicare Part D formularies. That means it is NOT COVERED under those plans — which is a different and generally worse outcome than requiring prior authorization. An exception or formulary-exception request may still be possible.

By product strength

RxNorm productPlans coveringRequire prior authStatus
24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]15937750 / 60Not on formulary
24 HR dapagliflozin 5 MG / metformin hydrochloride 500 MG Extended Release Oral Tablet [Xigduo]15938316 / 60No prior authorization
24 HR dapagliflozin 5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]15938330 / 60Not on formulary
24 HR dapagliflozin 10 MG / metformin hydrochloride 500 MG Extended Release Oral Tablet [Xigduo]15938356 / 60No prior authorization
24 HR dapagliflozin 2.5 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]19404986 / 60No prior authorization

Product names come from RxNorm (U.S. National Library of Medicine).

Source
Monthly Prescription Drug Plan Formulary and Pharmacy Network Information — Basic Drugs Formulary File
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.

Xigduo at other payers

Or see Xigduo across every payer at once.

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.