ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]

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ertugliflozin

RxCUI: 1992695

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.
0.5%
Plan Coverage
23
Plans Covering
T4
Avg Tier
33.3%
Prior Auth Required

What the CMS Formulary Data Shows for ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]

Per the CMS 2026 Part D formulary file, ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] (RxNorm concept RXCUI 1992695, generic name ertugliflozin) appears on 3 distinct formulary files spanning 23 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.

Real-world access to ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] depends on utilization management as much as tier placement: 33.3% of covering formularies require prior authorization. 66.7% require step therapy. 100% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 722 Part D beneficiaries filled ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] in 2023, with total plan-and-beneficiary spending of $1,266,291 and an average per-beneficiary annual cost of $1,753.87. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] today.

Coverage Details

Formularies covering
3
Plans covering
23
Coverage rate
0.5%
Tier range
Tier 4, Non-Preferred
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
33.3% of formularies
Step therapy required
66.7% of formularies
Quantity limits
100% of formularies

2023 Medicare Spending

Beneficiaries
722
Total spending
$1,266,291
Avg per beneficiary
$1,753.87

Tier Distribution Across Plans

23 plans
Tier 4, Non-Preferred

Medicare Advantage Plans (MA-PD) Covering ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]

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

Plan Insurer Tier PA Premium States
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare Dual (HMO D-SNP) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 UT
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Essential (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Flex (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare + Kroger (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Active (HMO) SELECTHEALTH, INC. T4 No $0 CO
Select Health Medicare Dual (HMO D-SNP) SELECTHEALTH, INC. T4 No $0 NV
Select Health Medicare Wellness (HMO) SELECTHEALTH, INC. T4 No $0 NV
Network Health Select (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $0 WI
Network Health Go (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $0 WI
Network Health Anywhere (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $0 WI
Network Health Choice (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $0 WI
Network Health Zero (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $0 WI
Healthy Mississippi Premier Advantage (HMO-POS) Healthy Mississippi, Inc. T4 No $0 MS
Network Health Cares (PPO D-SNP) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $21.10 WI
Network Health PlusRx (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $38.60 WI
Network Health PremierRx (PPO) NETWORK HEALTH INSURANCE CORPORATION T4 Yes $92.80 WI

Frequently Asked Questions

Is ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] covered by Medicare Part D?

Yes, ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] is covered by 23 Medicare Part D plans (0.5% of all Part D formularies).

What tier is ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] on Medicare Part D plans?

ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.

Does ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] require prior authorization?

33.3% of Part D formularies require prior authorization for ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]. Step therapy: 66.7%. Quantity limits: 100%.

How much does Medicare spend on ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet]?

In 2023, total Medicare Part D spending on ertugliflozin 2.5 MG / metformin hydrochloride 500 MG Oral Tablet [Segluromet] was $1,266,291, covering 722 beneficiaries. The average spend per beneficiary was $1,753.87.

Read our methodology - how this data is sourced, computed, and verified.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial