24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]

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24

RxCUI: 1593775

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
93%
Plan Coverage
4,710
Plans Covering
T2.7
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]

Under the CMS Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing public-use file for the 2026 contract year, 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] (RxNorm concept RXCUI 1593775, generic name 24) appears on 310 distinct formulary files spanning 4,710 Medicare Part D plan offerings. That equates to a national coverage rate of 93% of enrollable Part D products — a near-universal placement that most beneficiaries will find on whichever PDP or MA-PD contract they enroll in. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.7; lower tiers correspond to lower beneficiary copays or coinsurance under the plan's standard benefit design.

Utilization-management restrictions materially change how easily a beneficiary can actually fill 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] after enrollment. 0% of covering formularies require prior authorization — meaning the prescribing clinician must submit clinical justification to the plan before the pharmacy can dispense. 0.3% require step therapy, forcing trial of a lower-cost alternative first. 91.9% apply quantity limits on a per-fill or per-month basis. These three levers — PA, step therapy, and QL — are the standard Part D cost-containment tools and are recorded plan-by-plan in the CMS formulary file, so two plans listing the same tier can still differ sharply on actual dispensability.

Medicare Part D spending dashboard figures are not published for this drug. The table below shows every PDP and MA-PD currently listing 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]. Before enrolling, confirm the exact tier, prior-authorization status, and pharmacy-network pricing for your ZIP code using Medicare Plan Finder — the beneficiary-facing true-out-of-pocket amount depends on your stage within the Part D benefit (deductible, initial coverage, and the 2026 catastrophic cap at $2,000 annual OOP). This page is informational only; drug therapy decisions should be made with a licensed clinician and pharmacist.

Coverage Details

Formularies covering
310
Plans covering
4,710
Coverage rate
93%
Tier range
Tier 1 – Tier 6
Average tier
Tier 3 — Preferred Brand

Restrictions

Prior authorization required
0% of formularies
Step therapy required
0.3% of formularies
Quantity limits
91.9% of formularies

Tier Distribution Across Plans

100 plans
Tier 1 — Preferred Generic

Medicare Advantage Plans (MA-PD) Covering 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Sentara Community Complete Select (HMO D-SNP) SENTARA HEALTH PLANS T1 No $0 VA
Sentara Community Complete (HMO D-SNP) SENTARA HEALTH PLANS T1 No $0 VA
Florida Complete Care-Duals VIP (HMO-POS D-SNP) HPMP OF FLORIDA, INC. T1 No $0 FL
ElderServe MAP (HMO D-SNP) ELDERSERVE HEALTH, INC. T1 No $0 NY
Cooperative Advantage (HMO D-SNP) GROUP HEALTH COOPERATIVE OF EAU CLAIRE T1 No $0 WI
Longevity Health Plan (PPO I-SNP) LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP T1 No $0 NJ
Mercy Care Advantage (HMO D-SNP) MERCY CARE T1 No $0 AZ
Mercy Care Advantage (HMO D-SNP) MERCY CARE T1 No $0 AZ
Mercy Care Advantage (HMO D-SNP) MERCY CARE T1 No $0 AZ
Elderplan Plus Long-Term Care (HMO-POS D-SNP) ELDERPLAN, INC. T1 No $0 NY
Health Choice Pathway (HMO D-SNP) HEALTH CHOICE ARIZONA, INC. T1 No $0 AZ
Healthfirst CompleteCare (HMO D-SNP) HEALTHFIRST HEALTH PLAN, INC. T1 No $0 NY
IMCare Classic (HMO D-SNP) ITASCA MEDICAL CARE T1 No $0 MN
Johns Hopkins Advantage MD D-SNP (HMO D-SNP) HOPKINS HEALTH ADVANTAGE, INC. T1 No $0 MD
MetroPlus UltraCare (HMO D-SNP) METROPLUS HEALTH PLAN, INC. T1 No $0 NY
Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) UPPER PENINSULA HEALTH PLAN, LLC T1 No $0 MI
CareSource Dual Advantage (HMO D-SNP) CARESOURCE GEORGIA CO. T1 No $0 GA
Senior Whole Health SCO (HMO D-SNP) SENIOR WHOLE HEALTH, LLC T1 No $0 MA
Senior Whole Health SCO NHC (HMO D-SNP) SENIOR WHOLE HEALTH, LLC T1 No $0 MA
Molina One Care (HMO D-SNP) SENIOR WHOLE HEALTH, LLC T1 No $0 MA
HAP CareSource MI Coordinated Health (HMO D-SNP) HAP CARESOURCE T1 No $0 MI
PruittHealth Premier D-SNP (HMO D-SNP) PRUITTHEALTH PREMIER, INC. T1 No $0 GA
Simpra Advantage Dual Care (PPO D-SNP) SIMPRA ADVANTAGE, INC. T1 No $0 AL
Gold Coast Health Plan Total Care Advantage (HMO D-SNP) Ventura County Medi-Cal Managed Care Commission T1 No $0 CA
Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) HEALTH CARE SERVICE CORPORATION T1 No $0 NM
Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) HEALTH CARE SERVICE CORPORATION T1 No $0 NM
Horizon NJ TotalCare (HMO D-SNP) HORIZON HEALTHCARE OF NEW JERSEY, INC. T1 No $0 NJ
SecureBlue (HMO D-SNP) HMO Minnesota T1 No $0 MN
NaviCare (HMO D-SNP) FALLON COMMUNITY HEALTH PLAN T1 No $0 MA
Hamaspik Medicare Choice (HMO D-SNP) HAMASPIK, INC. T1 No $0 NY
SeniorCare Complete (HMO D-SNP) SOUTH COUNTRY HEALTH ALLIANCE T1 No $0 MN
AbilityCare (HMO D-SNP) SOUTH COUNTRY HEALTH ALLIANCE T1 No $0 MN
Alameda Alliance Wellness (HMO D-SNP) ALAMEDA ALLIANCE FOR HEALTH T1 No $0 CA
CCA One Care (HMO D-SNP) COMMONWEALTH CARE ALLIANCE, INC. T1 No $0 MA
CCA Senior Care Options (HMO D-SNP) COMMONWEALTH CARE ALLIANCE, INC. T1 No $0 MA
Elevate Medicare Choice (HMO D-SNP) DENVER HEALTH MEDICAL PLAN, INC. T1 No $0 CO
AllCare Advantage Redwood Rx (HMO D-SNP) ALLCARE HEALTH PLAN, INC. T1 No $0 OR
PrimeWest Senior Health Complete (HMO D-SNP) PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE T1 No $0 MN
Prime Health Complete (HMO D-SNP) PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE T1 No $0 MN
Alterwood Advantage Dual Secure (HMO D-SNP) ALTERWOOD ADVANTAGE, INC. T1 No $0 MD
Nascentia Dual Advantage (HMO D-SNP) VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK T1 No $0 NY
Provider Partners Pennsylvania Community Plan (HMO I-SNP) PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC T1 No $0 PA
Provider Partners North Carolina Community Plan (HMO I-SNP) PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA T1 No $0 NC
Provider Partners Indiana Community Plan (HMO I-SNP) PROVIDER PARTNERS HEALTH PLAN OF INDIANA T1 No $0 IN
Provider Partners Maryland Community Plan (HMO I-SNP) PROVIDER PARTNERS HEALTH PLAN, INC. T1 No $0 MD
Provider Partners Missouri Community Plan (HMO I-SNP) PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. T1 No $0 MO
Abilis Health Community (HMO I-SNP) SIGNATURE ADVANTAGE, LLC T1 No $0 KY, TN
Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) ARKANSAS SUPERIOR SELECT, INC. T1 No $0 AR
Platino Blindao (HMO D-SNP) TRIPLE S ADVANTAGE, INC. T1 No $0 PR
Platino Enlace (HMO D-SNP) TRIPLE S ADVANTAGE, INC. T1 No $0 PR

Frequently Asked Questions

Is 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] covered by Medicare Part D?

Yes, 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] is covered by 4,710 Medicare Part D plans, representing 93% of all Part D formularies. Coverage and tier placement vary by plan — check your specific plan's formulary for details.

What tier is 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] on Medicare Part D plans?

24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] is placed on an average of Tier 2.7 across Part D plans, with tier assignments ranging from Tier 1 to Tier 6. Lower tiers generally mean lower out-of-pocket costs.

Does 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo] require prior authorization?

0% of Part D formularies require prior authorization for 24 HR dapagliflozin 10 MG / metformin hydrochloride 1000 MG Extended Release Oral Tablet [Xigduo]. Step therapy is required by 0.3% of formularies. Quantity limits apply on 91.9% of formularies.

Source: CMS Quarterly Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information (SPUF) 2026. Drug name from NLM RxNorm (RXCUI: 1593775). Spending data from CMS Medicare Part D Drug Spending Dashboard 2023. Data is for informational purposes only and is not a guarantee of coverage.

Related

Data sourced from official U.S. government datasets. See our methodology for details. Retrieved and formatted by PlainMedicare Editorial