Date: 2014-08-07 16:26:15

Amides

Anti-diabetic drugs

Alcohols

Nitriles

Sitagliptin

Saxagliptin

Metformin

Pharmacist

Dipeptidyl peptidase

Chemistry

Dipeptidyl peptidase-4 inhibitors

Organic chemistry

UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Dipeptidyl Peptidase IV (DPP-4) Inhibitors (alogliptin, linagliptin, saxagliptin, sitagliptin and combination products) Patient name:_________________________

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