Does New York Quality Healthcare Corporation require prior authorization for Glyxambi?
New York Quality Healthcare Corporation does not require prior authorization for Glyxambi on the Medicare Part D plans that cover it.
No covering plan from this payer files a prior-authorization requirement for this drug.
By product strength
| RxNorm product | Plans covering | Require prior auth | Step therapy | Qty limit | Status |
|---|---|---|---|---|---|
| empagliflozin 10 MG / linagliptin 5 MG Oral Tablet [Glyxambi]1602115 | 9 / 9 | 0 | 0 | 9 | No prior authorization |
| empagliflozin 25 MG / linagliptin 5 MG Oral Tablet [Glyxambi]1602120 | 9 / 9 | 0 | 0 | 9 | No prior authorization |
Product names come from RxNorm (U.S. National Library of Medicine).
Plan-by-plan detail — empagliflozin 10 MG / linagliptin 5 MG Oral Tablet [Glyxambi]
Glyxambi has 2 products in the corpus; this table is for empagliflozin 10 MG / linagliptin 5 MG Oral Tablet [Glyxambi], the one carried on the most plans. The product table above covers every strength.
| Plan | Contract | Tier | Prior auth | Step therapy | Qty limit |
|---|---|---|---|---|---|
| Wellcare Assist (HMO-POS) | H4868-016 | 3 | No | No | Yes |
| Wellcare Dual Access (HMO D-SNP) | H4868-004 | 3 | No | No | Yes |
| Wellcare Dual Access (HMO D-SNP) | H4868-014 | 3 | No | No | Yes |
| Wellcare Fidelis Assist (HMO-POS) | H5599-002 | 3 | No | No | Yes |
| Wellcare Fidelis Dual Align (HMO D-SNP) | H5599-003 | 3 | No | No | Yes |
| Wellcare Fidelis Dual Liberty Sync (HMO D-SNP) | H5599-013 | 3 | No | No | Yes |
| Wellcare Fidelis Dual Liberty Sync (HMO D-SNP) | H5599-013 | 3 | No | No | Yes |
| Wellcare Fidelis Simple (HMO-POS) | H5599-004 | 3 | No | No | Yes |
| Wellcare Simple (HMO-POS) | H4868-019 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
- e626e6bcda1aa6a0071e6f0df6bafe686ae41842cdf0a9feffdc649b6d3ff3ae
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Glyxambi 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.