In the September issue of Insights and Updates for Providers, we outlined formulary changes regarding sodium-glucose cotransporter 2 (SGLT2) inhibitor drugs coming Nov. 15, 2026 for Commercial large group members. 

Effective for fill dates on or after Jan. 1, 2027, we’re implementing a similar generic-first SGLT2 inhibitor strategy for small group and individual Harvard Pilgrim Health care members and individual Tufts Health Plan Direct members, transitioning members from higher-cost brand name drugs to equivalent lower-cost generics or generic alternatives.

The following brand name SGLT2 inhibitor drugs will move to non-formulary status for all individual/small group formularies, and generic dapagliflozin, or combination dapagliflozin/metformin ER, will be preferred:

  • Glyxambi
  • Jardiance
  • Synjardy
  • Synjardy XR
  • Trijardy XR
  • Farxiga
  • Xigduo XR

In addition, the following drugs will also be up-tiered and require prior authorization for the specified formularies. 

  • Glyxambi will be up-tiered and require prior authorization on the CoreMA, CoreME, and THPP Direct formularies.
  • Trijardy XR will be up-tiered and require prior authorization on the CoreMA, CoreME, CoreNH, and THPP Direct formularies.

Members who are currently on Farxiga or Xigduo XR will be transitioned to generic equivalents automatically at the pharmacy and no action is needed. For members who are on any of the other brand drugs moving to non-formulary status, a new prescription for a preferred product will need to be written. For a member to continue using one of these non-formulary medications, the prescribing provider must request coverage as an exception through the medical review process subject to the Medical Necessity Guidelines for Non-Formulary Exceptions and Empagliflozin Containing Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors.