Prior Authorization/Medical Necessity Custom Oxford SoNY and SoCT SGLT2 Inhibitors
UnitedHealthcare prior authorization/medical necessity program for SGLT2 inhibitors (specific agents and combinations) defining step/failure criteria for indications including heart failure, chronic kidney disease with/without diabetes, and glycemic control; includes continuation/automated approvals and authorization durations. Applies to specified commercial/Oxford plans with program-specific effective dates and state mandate notes.
Added Brenzavvy (bexagliflozin) to criteria.
Added Inpefa (sotagliflozin) to criteria.
Annual review and updated excluded products; clarified authorized_generic labeling for bexagliflozin.
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.