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Diabetic Step Therapy Update for 2021

Audience: Providers of impacted patients

We would like you to be aware of an upcoming policy update involving select diabetic prescription medications listed in the table below. Starting January 1, 2021, step therapy requirements for these medications will apply to new and existing users under our commercial 3-Tier prescription drug plans for the diabetic categories below.

 

Drug Class: Diabetes

Category

If your patient currently uses:

They must try an alternative:

GLP1

Byetta, Bydureon, Adlyxin

Trulicity, Ozempic, or Victoza (two out of three)

Rapid Acting Insulin

Fiasp®

Humalog® or Insulin Lispro

Rapid Acting Insulin

NovoLog®, Insulin Aspart

Humalog® or Insulin Lispro

Rapid Acting Insulin

Admelog

Humalog® or Insulin Lispro

Rapid Acting Insulin

Apidra®

Humalog® or Insulin Lispro

DPP4

Alogliptin, Alogliptin/Metformin, Alogliptin/Pioglitazone

Januvia, Janumet, Tradjenta, or Jentadueto

DPP4

Nesina, Kazano, Oseni

Januvia, Janumet, Tradjenta, or Jentadueto

DPP4

Onglyza, Kombiglyze XR

Januvia, Janumet, Tradjenta, or Jentadueto

Metformin

Glumetza (and its generic equivalent Metformin ER)

Metformin IR and Metformin ER (generic equivalent to Glucophage XR)


A list of your patients, who may have been prescribed these medications in the last four months, is printed on the reverse.

If you feel that the alternative formulary medications are not the right choice for your patient, you and your staff can request a coverage determination electronically, directly from your electronic medical record (EMR) or through CoverMyMeds ePA portal. Visit covermymeds.com for additional information on CoverMyMeds and electronic prior authorizations. Submission of the prior authorization form does not guarantee coverage.

As an alternative, complete our Request for Step Therapy Evaluation form available here. The completed form should be faxed to our Pharmacy Help Desk for therapy consideration.

If submitting a request for step therapy evaluation, please include all of the following relevant clinical information:

  • Clinical justification as to why the alternative drug is not the best choice for your patient and/or;
  • Rationale as to why you are requesting a step therapy protocol override is also required


If you have any questions about this information, please call 1-800-920-8889.
Thank you for the quality of care and service that you provide to our members.
 

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