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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