Pharmacologic Agents for Treatment of Type 2 Diabetes SCAN Formulary Drugs 2020 2021 Risk for Dosing & Drug- Drug Medication Formulary Formulary Adverse Drug Reactions Administration Interactions Tier UM Tier UM * Biguanides 500 – 850 mg Nausea/ vomiting, GI upset, metallic taste, metformin tabs 1 1 QD - TID diarrhea, flatulence, lactic acidosis (rare) metformin er Neutral 500 – 2000 mg Nausea/ vomiting, GI upset, diarrhea, flatulence, uncoated tabs 1 1 daily lactic acidosis 500 mg & 750 mg Sulfonylureas Dizziness, headache, hypoglycemia, nausea, glimepiride 1 1 1 – 8 mg daily weight gain 2.5 – 20 mg Rash, diarrhea, dizziness, headache, diarrhea, glipizide 1 1 daily Moderate hypoglycemia, nausea, weight gain Asthenia, headache, dizziness, rash, nausea, glipizide er 1 1 5 – 20 mg daily hypoglycemia, weight gain glipizide / 2.5 / 500 mg Rash, diarrhea, dizziness, headache, nausea, 1 1 Moderate metformin tabs BID flatulence, hypoglycemia, lactic acidosis Thiazolidinediones & Thiazolidinedione Combination Agents 15 – 45 mg Anemia, edema, weight gain, headache, myalgia, pioglitazone 1 1 daily bone fracture, heart failure 15 / 500 mg – pioglitazone / Rash, diarrhea, dizziness, headache, nausea, 2 2 45 / 1500mg metformin Neutral flatulence, hypoglycemia, lactic acidosis daily 15 / 500 mg – pioglitazone / Anemia, edema, weight gain, headache, myalgia, 2 [QL] 2 [QL] 45 / 2550 mg glimepiride dizziness, hypoglycemia, nausea daily R. Brower and N. Nguyen rev. 11/2012; R. Brower rev. 11/2013, 9/2014, 11/2015; D. Yoon rev 8/2016, 11/2016, 8/2017; K. Truong 9/2018; D. Yoon 9/2019, 8/2020 2020 2021 Risk for Dosing & Drug- Drug Medication Formulary Formulary Adverse Drug Reactions Administration Interactions Tier UM Tier UM * Alpha-Glucosidase Inhibitor 25 – 100 mg TID Administered at the start of Abdominal pain, diarrhea, flatulence, elevated acarbose 2 2 Neutral each meal to serum transaminases decrease postprandial glucose peaks Meglitinides 60 – 120 mg Dizziness, arthralgia, diarrhea, hypoglycemia, nateglinide 2 2 TID before weight gain, increased uric acid meals Moderate 0.5 – 4 mg TID repaglinide 2 2 Hypoglycemia, arthralgia, diarrhea, weight gain before meals DPPIs (Dipeptidyl Peptidase-4 Inhibitors) JANUMET, Abdominal pain, diarrhea, headache, JANUMET XR 100 / 2000 mg 3 3 nasopharyngitis, nausea, flatulence, lactic acidosis, (sitagliptin / daily pancreatitis metformin) JANUVIA Neutral Abdominal pain, diarrhea, headache, 3 3 100 mg daily (sitagliptin) nasopharyngitis, nausea, URI, pancreatitis KOMBIGLYZE XR Individualize Nausea/ vomiting, GI upset, asthenia, diarrhea, (saxagliptin / 3 3 dose; 5 / 2000 flatulence, lactic acidosis, pancreatitis metformin) mg daily max ONGLYZA Abdominal pain, diarrhea, URI, pancreatitis, 3 3 2.5 – 5 mg daily (saxagliptin) nausea, hypoglycemia R. Brower and N. Nguyen rev. 11/2012; R. Brower rev. 11/2013, 9/2014, 11/2015; D. Yoon rev 8/2016, 11/2016, 8/2017; K. Truong 9/2018; D. Yoon 9/2019, 8/2020 2020 2021 Risk for Dosing & Drug- Drug Medication Formulary Formulary Adverse Drug Reactions Administration Interactions Tier UM Tier UM * Insulins Pe Vial Pen Vial n HUMALOG 3 3 3 3 HUMALOG MIX 3 3 3 3 50/50, 75/25 HUMULIN 70/30 3 3 3 3 HUMULIN N 3 3 3 3 Patient specific Hypoglycemia, injection site reaction, Neutral HUMULIN R 3 - 3 - dosing applies lipodystrophy, hypokalemia HUMULIN R U-500 3 3 3 3 LANTUS 3 3 3 3 (insulin glargine) LYUMJEV 3 3 3 3 TOUJEO/ MAX - 3 - 3 GLP-1 Agonist (Glucagon-Like-Peptide-1) BYDUREON 2 mg SC 3 [PA] 3 [ST] (exenatide er) weekly Diarrhea, nausea, vomiting, constipation, Neutral BYETTA 5 – 10 mcg SC headache, pancreatitis 3 [PA] 3 [ST] (exenatide) BID OZEMPIC 0.5 – 1 mg Diarrhea, nausea, vomiting, constipation, 3 [PA] 3 [ST] Neutral (semaglutide) weekly headache, pancreatitis RYBELSUS 0.5 – 1 mg Diarrhea, nausea, vomiting, constipation, - - 3 [ST] Neutral (semaglutide) weekly headache, pancreatitis TRULICITY 0.75 – 1.5 mg Diarrhea, nausea, vomiting, constipation, 4 [PA] 3 [ST] Neutral (dulaglutide) weekly headache, pancreatitis VICTOZA 0.6 mg – 1.8mg Diarrhea, nausea, vomiting, constipation, 3 [PA] 3 [ST] Neutral (liraglutide) SC daily headache, pancreatitis R. Brower and N. Nguyen rev. 11/2012; R. Brower rev. 11/2013, 9/2014, 11/2015; D. Yoon rev 8/2016, 11/2016, 8/2017; K. Truong 9/2018; D. Yoon 9/2019, 8/2020 2020 2021 Risk for Dosing & Drug- Drug Medication Formulary Formulary Adverse Drug Reactions Administration Interactions Tier UM Tier UM * Amylinomimetic 60 mcg – 120 SYMLIN PEN 5 [PA] 5 [PA] mcg SC prior to Neutral Nausea, anorexia, dizziness, fatigue (pramlintide) main meals SGLT2 Inhibitor (Sodium-Glucose Cotransporter 2) FARXIGA [ST Genital mycotic infections, nasopharyngitis, UTI, 3 [ST] 3 5 – 10 mg daily (dapagliflozin) ] back pain, increased urination, nausea INVOKAMET Abdominal discomfort, constipation, diarrhea, [ST 50 / 500 – 150 / (canagliflozin/ 3 [ST] 3 flatulence, increased thirst, indigestion, N/V, ] 1000 mg BID metformin) asthenia, headache, UTI, polyuria pruritis INVOKAMET XR 100 / 1000 – Neutral Abdominal discomfort, constipation, diarrhea, [ST (canagliflozin/ 3 [ST] 3 300 / 2000 mg flatulence, increased thirst, indigestion, N/V, ] metformin) daily asthenia, headache, UTI, polyuria pruritis INVOKANA [ST 100 – 300 mg Genital mycotic infections, UTI, thirst, increased 3 [ST] 3 (canagliflozin) ] daily urination, nausea XIGDUO XR [ST 5 / 500 – 10 / Low vitamin-B12, diarrhea, headache, UTI, genital (dapagliflozin/ 3 [ST] 3 ] 2000 mg daily mycotic infection, nasopharyngitis metformin) Brand-name drugs are capitalized and generic drugs are listed in the lower-case italics. [NF] = Non-formulary [PA] = Prior Authorization [QL] = Quantity Limit [ST] = Step Therapy * 2019 AACE/ACE Consensus Statement R. Brower and N. Nguyen rev. 11/2012; R. Brower rev. 11/2013, 9/2014, 11/2015; D. Yoon rev 8/2016, 11/2016, 8/2017; K. Truong 9/2018; D. Yoon 9/2019, 8/2020 Diabetes Guidelines References SCAN Health Plan Diabetes Guidelines adapted from: • American Diabetes Association; Standards of Medical Care in Diabetes-2020: Diabetes Care January 2020 vol. 43 no. Supplement 1 S1-S212 https://care.diabetesjournals.org/content/diacare/suppl/2019/12/20/43.Supplement_1.DC1/ Standards_of_Care_2020.pdf • Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Comprehensive Type 2 Diabetes Management Algorithm – 2020 Executive Summary. Endocrine Practice. (2020, January). Vol. 26, No. 1, pp. 107-139. • Drug Facts & Comparisons. (2020, August). Retrieved from www.online.factsandcomparisons.com. W olters Kluwer Health: Deventer, TheNetherlands. • Epocrates Online (2020, August). Retrieved from: http://online.epocrates.com. Epocrates, Inc.: San Mateo, California. • Reuben, D. B., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2015). Geriatrics at your fingertips. 17th ed. (Based on AGS Guidelines.) • Online Lexicomp (08/2020): 1100 Terex Road, Hudson, OH 44236 .