CurrentCignaPolicy N/A

Diabetes - Dipeptidyl Peptidase-4 Inhibitors Step Therapy Policy

Defines Cigna's step therapy requirements for coverage of dipeptidyl peptidase-4 (DPP-4) inhibitors and specified combination products for adults with type 2 diabetes; applies to health benefit plans administered by Cigna companies.

Policy Summary

PayerCigna

PolicyDPP-4 inhibitors step therapy for type 2 diabetes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMay 14, 2025

Key ActionObtain documentation of trial of a Step 1 product (e.g., metformin) or prescriber-documented metformin contraindication before approving a Step 2 DPP-4 product.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Step 1 then Step 2Required prior therapy pathway

1 yearApproval duration for approvals

20+Named DPP-4 and combination products listed

05/14/2025Policy last reviewed

Coverage Criteria — DPP-4 Inhibitors and Combinations

Initial and Step Therapy Criteria

Covered when ONE of the following conditions is met:

Step 1 trial: Patient has tried one Step 1 product (generic metformin or generic metformin extended-release)trial of one product

Step 1 products listed in policy include generic metformin and generic metformin ER (generic to Glucophage XR)

Metformin-containing product trial: Patient has tried one of the listed metformin-containing products (examples include Glumetza ER, Riomet, metformin oral solution, metformin extended-release generics to Fortamet ER and Glumetza ER, glyburide/metformin, glipizide/metformin, Actoplus Met, pioglitazone/metformin, Invokamet, Invokamet XR, Synjardy, Synjardy XR, Xigduo XR, dapagliflozin/metformin extended-release, Segluromet)trial of one product

Per policy, a trial of any one of these metformin-containing products satisfies the Step 1 requirement; some listed products are noted as obsolete but still count toward trial

Policy Summary

PayerCigna

PolicyDPP-4 inhibitors step therapy for type 2 diabetes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateMay 14, 2025

Key ActionObtain documentation of trial of a Step 1 product (e.g., metformin) or prescriber-documented metformin contraindication before approving a Step 2 DPP-4 product.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Named Products and Coding

Named DPP-4 and Combination ProductsNDC

Janumet (sitagliptin/metformin) - Merck	Named product (NDCs not listed)
Janumet XR (sitagliptin/metformin XR) - Merck	Named product (NDCs not listed)
Januvia (sitagliptin) - Merck	Named product (NDCs not listed)
Jentadueto (linagliptin/metformin) - Boehringer Ingelheim	Named product (NDCs not listed)
Jentadueto XR (linagliptin/metformin XR) - Boehringer Ingelheim	Named product (NDCs not listed)
Kazano (alogliptin/metformin) - Takeda (authorized generic)	Named product (NDCs not listed)
Alogliptin/metformin tablets - A-S Medication	Named product (NDCs not listed)
Kombiglyze XR (saxagliptin/metformin XR) - AstraZeneca (generic)	Named product (NDCs not listed)
Nesina (alogliptin) - Takeda (authorized generic)	Named product (NDCs not listed)
Alogliptin tablets - multiple manufacturers	Named product (NDCs not listed)

1–10 of 16

1/2

Provider Actions and Requirements

Note

Coverage determinations — consider plan, laws, collateral materials

Coverage determinations require consideration of multiple items. Reviewers must consider the terms of the applicable benefit plan document in effect on the date of service, any applicable laws and regulations, relevant collateral materials (including coverage policies), and the specific facts of the individual case. Medical directors have discretion to exercise clinical judgment when making individual coverage decisions.

Denial Risk

Denial risk — claims without covered codes will be denied

Claims submitted without covered diagnosis and/or procedure codes that match this coverage policy will be denied as not covered. When billing, providers must use the most appropriate codes as of the effective date of submission; services billed for conditions or diagnoses that are not covered under this policy will be denied.

Step Therapy

Step therapy required — must try Step 1 product first

Step therapy requirement — coverage of a Step 2 DPP‑4 inhibitor requires prior trial of one Step 1 product (or an allowed metformin-containing product) unless criteria for exception are met. All approvals are provided for 1 year.

Acceptable Step 1: generic metformin or generic metformin extended‑release (generic to Glucophage XR only).
Metformin-containing products that satisfy Step 1: Glumetza ER, Riomet, metformin oral solution, metformin extended‑release (generics to Fortamet ER and Glumetza ER), glyburide/metformin, glipizide/metformin, Actoplus Met, pioglitazone/metformin, Invokamet, Invokamet XR, Synjardy, Synjardy XR, Xigduo XR, dapagliflozin/metformin extended‑release, Segluromet.
A prior trial of one Step 2 product also satisfies the requirement for coverage of another Step 2 product per policy criteria.
If the patient has a contraindication to metformin (as reported by the prescriber), a single‑entity DPP‑4 inhibitor may be approved without prior metformin trial.

Background

Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral antihyperglycemic agents indicated to improve glycemic control in adults with type 2 diabetes mellitus as monotherapy or in combination with diet and exercise. They are available as single‑entity agents and in multiple combination products (with metformin, SGLT-2 inhibitors, and/or thiazolidinediones). Per this policy, DPP-4 agents are positioned as Step 2 options after a trial of a Step 1 product (typically generic metformin or generic metformin extended‑release), or after trial of specified metformin‑containing products, unless a metformin contraindication is documented or dual therapy is being initiated.

Definitions

inv-10: DPP-4 inhibitors — definition and clinical use

DefinitionOral antihyperglycemic agents indicated to improve glycemic control in adults with type 2 diabetes mellitus as monotherapy or in combination therapy (adjuncts to diet and exercise).

Clinical roleRecommended as add-on therapy after metformin for patients who need additional glycemic control; used as monotherapy or in combination with other agents.

Combination productsAvailable in combinations with metformin, SGLT-2 inhibitors, and/or thiazolidinediones; SGLT-2/DPP-4 combinations are not addressed in this policy (see related SGLT-2/DPP-4 step therapy policy).

Efficacy noteGenerally lower glycemic efficacy than some other drug classes and lack cardiorenal indications.

Policy purposePolicy encourages use of a Step 1 product prior to Step 2 DPP-4 products as part of step therapy requirements.

inv-11: Metformin contraindication example — example contraindications and eGFR threshold

Example contraindicationsAcute or chronic metabolic acidosis, including diabetic ketoacidosis (with or without coma).

Renal impairment thresholdSevere renal impairment defined as estimated glomerular filtration rate (eGFR) < 30 mL/min/1.73 m2 — metformin is contraindicated at or below this threshold.

Prescriber documentationIf prescriber documents a contraindication to metformin, a single‑entity DPP-4 inhibitor may be approved per the step therapy criteria.

Clinical implicationPatients with the listed contraindications to metformin may proceed directly to single‑entity DPP-4 therapy per policy criteria.