CurrentColorado Rocky Mountain Health PlansPolicy N/A

Invokana (canagliflozin) — Coverage Criteria

Defines coverage and authorization criteria for Invokana (canagliflozin) as a non-formulary outpatient medication for members, including initial authorization and reauthorization requirements. Applies to prescribers and pharmacy reviewers managing Invokana therapy.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyInvokana (canagliflozin) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMay 1, 2026

Next Review DateFeb 1, 2026

Key ActionSubmit prior authorization with documentation of type 2 diabetes and diabetic nephropathy (albuminuria >300 mg/day) and attest that Jardiance is not suitable.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 moauthorization period

>300 mg/dayalbuminuria criterion

eGFR <30renal function limit

through 2/2026P&T review

Coverage Criteria — Invokana (canagliflozin)

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Initial Therapy

Covered when ALL of the following are met:

Initial Authorization: Member has a diagnosis of type 2 diabetes mellitus

Initial Authorization: Member has diabetic nephropathy with albuminuria > 300 mg/day> 300 mg/day

Initial Authorization: Provider attests that Jardiance (empagliflozin) is not a suitable treatment option

Provider attestation required (step therapy)

Initial Authorization: Submission of medical records (laboratory and clinical documentation) confirming diagnosis of kidney disease

Authorization issued for 12 months

Continuation Therapy / Reauthorization

Reauthorization requires:

Reauthorization: Documentation of a positive clinical response to Invokana therapy

Authorization issued for 12 months on reapproval

Canagliflozin (Invokana) is not recommended for improving glycemic control in patients with type 2 diabetes mellitus who have an eGFR < 30 mL/min/1.73 m2. This renal function threshold should be applied when considering Invokana for glycemic management; use alternative therapies or specialist consultation for patients below this cutoff.

Provider Actions and Documentation Requirements

Prior Authorization

Prior Authorization Required

Prior authorization is required. Initial approvals will be issued only when all initial criteria are met, including diagnosis of type 2 diabetes mellitus and diabetic nephropathy with albuminuria. Authorization duration: 12 months.

Initial authorization required for Invokana (canagliflozin).
Authorization duration: 12 months.

Step Therapy

Preferred Agent Attestation

Provider must attest that Jardiance (empagliflozin) is not a suitable treatment option before approval will be granted as a step-therapy exemption.

Attestation that Jardiance is not suitable is required.

Documentation Required

Documentation Required for Approval

Medical records must be submitted to support the diagnosis and meet the initial authorization criteria. Incomplete documentation may result in denial.

Submit laboratory and clinical documentation confirming kidney disease and albuminuria (> 300 mg/day).
Failure to document diagnosis or to provide required attestation may lead to denial.

Background

Invokana (canagliflozin) is indicated as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus aged 10 years and older, to reduce the risk of major adverse cardiovascular events in adults with established cardiovascular disease, and to reduce the risk of end-stage kidney disease and related outcomes in adults with diabetic nephropathy with albuminuria greater than 300 mg/day. It is explicitly not recommended for glycemic control in patients with an eGFR less than 30 mL/min/1.73 m2.

Initial Authorization Criteria (Detailed)

Initial authorization

Initial coverage requires all of the following

Initial authorization: Diagnosis of type 2 diabetes mellitus

Initial authorization: Diagnosis of diabetic nephropathy with albuminuria > 300 mg/day> 300 mg/day

Initial authorization: Provider attestation that Jardiance (empagliflozin) is not a suitable treatment option

Step requirement: attestation required

Initial authorization: Submission of medical records confirming kidney disease (laboratory and clinical documentation)