Dapagliflozin (Farxiga®)


Indications for Prior Authorization:

  • Indicated as an adjunct to diet and exercise to improve glycemic control in adults with Type 2 Diabetes Mellitus
  • Limitation of use: Farxiga is not recommended for patients with Type 1 Diabetes Mellitus or for the treatment of Diabetic Ketoacidosis

Patients must meet the following criteria for the indication(s) above:

  • Patient has a diagnosis of Type 2 Diabetes Mellitus, AND
  • Patient has tried and failed Invokana® or Jardiance®, AND
  • Patient does not have a contraindication to therapy: severe renal impairment (eGFR less than 30 mL/min), end-stage renal disease (ESRD), or patients on dialysis


  • Starting dose: 5mg once daily
  • Maximum dose: 10mg once daily


  • 1 year

Last review date: May 13, 2019

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