Does Upmc Health Network, INC. require prior authorization for Glyxambi?
Upmc Health Network, INC. 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 | 12 / 12 | 0 | 0 | 12 | No prior authorization |
| empagliflozin 25 MG / linagliptin 5 MG Oral Tablet [Glyxambi]1602120 | 12 / 12 | 0 | 0 | 12 | 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 |
|---|---|---|---|---|---|
| UPMC for Life PPO Essential Care Rx (PPO) | H5533-017 | 3 | No | No | Yes |
| UPMC for Life PPO Essential Care Rx (PPO) | H5533-017 | 3 | No | No | Yes |
| UPMC for Life PPO High Deductible Rx (PPO) | H5533-003 | 3 | No | No | Yes |
| UPMC for Life PPO Premier Rx (PPO) | H5533-011 | 3 | No | No | Yes |
| UPMC for Life PPO Premier Rx (PPO) | H5533-013 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Choice (PPO) | H5533-015 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Choice (PPO) | H5533-015 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Choice (PPO) | H5533-015 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Choice (PPO) | H5533-015 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Choice (PPO) | H5533-015 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Enhanced (PPO) | H5533-005 | 3 | No | No | Yes |
| UPMC for Life PPO Rx Enhanced (PPO) | H5533-008 | 3 | No | No | Yes |
- Effective
- 2026-06-30
- Retrieved
- 2026-07-19
- SHA-256
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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.