Get the free JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM

This form is used to request prior authorization for coverage of DPP-4 inhibitors like Januvia and Janumet for patients with Type 2 Diabetes Mellitus, requiring documentation of treatment criteria

How to fill out januvia janumet sitagliptin sitagliptinmetformin

How to fill out JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM

1. Obtain the JANUVIA / JANUMET Prior Authorization Form from your healthcare provider or insurance company.
2. Fill in the patient's personal information, including name, date of birth, and insurance information.
3. Provide details of the prescribing physician, including name, contact information, and NPI number.
4. Indicate the specific medication being requested (JANUVIA or JANUMET) and the dosage.
5. Include a diagnosis code that supports the need for the medication, such as Type 2 Diabetes.
6. Document previous medications tried and any relevant medical history that justifies the use of JANUVIA / JANUMET.
7. Sign and date the form, if required, to authorize the release of medical information if necessary.
8. Submit the completed form to the insurance company via fax or online portal as directed.

Who needs JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

1. Patients diagnosed with Type 2 Diabetes who require medication to manage their blood sugar levels.
2. Individuals who have not adequately controlled their diabetes with other medications and need a more effective treatment option.
3. Patients whose insurance plan requires prior authorization for JANUVIA or JANUMET before coverage begins.

People Also Ask about

Can I get Janumet for free?

This private and confidential program provides product free of charge to eligible individuals, primarily the uninsured who, without our assistance, could not afford needed Merck medicines.

What is Janumet a combination of?

JANUMET (JAN-you-met) is an oral prescription medicine that, along with diet and exercise, helps lower blood sugar in adults with type 2 diabetes. JANUMET tablets contain 2 prescription medicines: sitagliptin (JANUVIA®) and metformin.

How much does a 30 day supply of Janumet cost?

How much does a 30-day supply of Janumet cost? Janumet costs about $720 for 60 tablets of 50 mg/1000 mg at the full retail price.

Is janumet a combination of Januvia and metformin?

Once-daily prescription JANUMET XR (JAN-you-met XR) tablets contain sitagliptin (the medicine in JANUVIA®) and extended-release metformin. JANUMET or JANUMET XR can be used along with diet and exercise to lower blood sugar in adults with type 2 diabetes.

Does insurance cover Janumet?

Many health insurance and Medicare Part D drug coverage plans cover a Janumet or Janumet XR prescription, including major insurers such as Aetna, Cigna, and Kaiser Permanente. Medicaid coverage varies by state. Insurance companies tend to place Janumet and Janumet XR in their higher copay tiers.

Is Janumet covered by insurance?

Metformin, one of the medicines in JANUMET, can cause a rare but serious condition called lactic acidosis (a buildup of an acid in the blood) that can cause death. Lactic acidosis is a medical emergency and must be treated in the hospital.

What is the new combination drug for metformin?

SYNJARDY XR is a prescription medicine that contains 2 diabetes medicines, empagliflozin (JARDIANCE) and metformin HCl extended-release. SYNJARDY can be used along with diet and exercise to improve blood sugar in adults and children who are 10 years of age and older with type 2 diabetes.

Is Janumet a high risk medication?

Metformin, one of the medicines in JANUMET, can cause a rare but serious condition called lactic acidosis (a buildup of an acid in the blood) that can cause death. Lactic acidosis is a medical emergency and must be treated in the hospital.

Can I take Januvia and Janumet together?

It's generally safe for most people to take both sitagliptin and metformin if needed. The two medications work in different ways to lower glucose levels.

For pdfFiller’s FAQs

What is JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

The JANUVIA / JANUMET PRIOR AUTHORIZATION FORM is a document required by healthcare providers to obtain approval from insurance companies before prescribing these medications, which are used to manage type 2 diabetes.

Who is required to file JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

Healthcare providers, such as doctors or pharmacists, are required to file the prior authorization form on behalf of patients who need prescription coverage for JANUVIA or JANUMET from their insurance provider.

How to fill out JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

To fill out the form, the healthcare provider must provide patient information, medical history, current medications, rationale for the prescription, and any previous treatments that were considered or tried.

What is the purpose of JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

The purpose of the prior authorization form is to ensure that the medications are medically necessary and that the insurance company agrees to cover the cost of these prescriptions.

What information must be reported on JANUVIA / JANUMET (sitagliptin; sitagliptin/metformin) PRIOR AUTHORIZATION FORM?

The form must report patient demographics, diagnosis, treatment history, prescribing physician's information, and justification for the use of JANUVIA or JANUMET in the patient's treatment plan.