Dapagliflozin (Farxiga®)

SELF ADMINISTRATION

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

Dosing:

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

Approval:

  • 1 year

Last review date: May 13, 2019