HYPOGLYCEMICS: INCRETIN MIMETICS/ENHANCERS

Brand Name/Generic Name	NDC/Manufacturer	FFS Clinical Prior Auth Required	PDL Prior Auth Required	Programs
BYETTA 10 MCG DOSE PEN INJ exenatide	00310652401 ASTRAZENECA	Yes	No	Medicaid CHIP CSHCN
BYETTA 5 MCG DOSE PEN INJ exenatide	00310651201 ASTRAZENECA	Yes	No	Medicaid CHIP CSHCN
GLYXAMBI 10 MG-5 MG TABLET empagliflozin/linagliptin	00597018230 BOEHRINGER ING.	Yes	No	Medicaid CHIP CSHCN
GLYXAMBI 10 MG-5 MG TABLET empagliflozin/linagliptin	00597018239 BOEHRINGER ING.	Yes	No	Medicaid CHIP CSHCN
GLYXAMBI 10 MG-5 MG TABLET empagliflozin/linagliptin	00597018290 BOEHRINGER ING.	Yes	No	Medicaid CHIP CSHCN
GLYXAMBI 25 MG-5 MG TABLET empagliflozin/linagliptin	00597016430 BOEHRINGER ING.	Yes	No	Medicaid CHIP CSHCN
GLYXAMBI 25 MG-5 MG TABLET empagliflozin/linagliptin	00597016490 BOEHRINGER ING.	Yes	No	Medicaid CHIP CSHCN
JANUMET 50-1,000 MG TABLET sitagliptin phos/metformin HCl	00006057761 MERCK SHARP & D	Yes	No	Medicaid CHIP CSHCN
JANUMET 50-1,000 MG TABLET sitagliptin phos/metformin HCl	00006057762 MERCK SHARP & D	Yes	No	Medicaid CHIP CSHCN
JANUMET 50-1,000 MG TABLET sitagliptin phos/metformin HCl	00006057782 MERCK SHARP & D	Yes	No	Medicaid CHIP CSHCN