Limited coverage drugs – insulin glargine

 

Generic name

 insulin glargine

Strength

100 U/mL
Form

solution for injection

Basaglar® or Semglee® brands of insulin glargine are eligible for coverage. 

Special Authority criteria

Approval period

Type 1 Diabetes Mellitus

The patient has Type 1 Diabetes requiring insulin and is currently taking insulin NPH and/or pre-mix insulin daily at optimal dosing.

AND

  1. Has experienced unpredictable nocturnal hypoglycemia at least once a month despite optimal management.

OR

  1. Has experienced or continues to experience severe, systemic or local allergic reaction to current insulin treatment.

Indefinite

Type 2 Diabetes Mellitus

The patient has Type 2 Diabetes requiring insulin and is currently taking insulin NPH and/or pre-mix insulin daily at optimal dosing.

AND

The patient is 17 years of age or older.

AND

  1. Has experienced unpredictable nocturnal hypoglycemia at least once a month despite optimal management.

OR

  1. Has experienced or continues to experience severe, systemic or local allergic reaction to current insulin treatment.

Indefinite

Practitioner exemptions

  • Endocrinologists are not required to submit a Special Authority Request form for coverage.

Special notes

  • For patients who have experienced or continue to experience severe, systemic or local allergic reactions to existing insulin treatment, documentation of previous trials (i.e., specific insulin tried and patient's response) is required.
  • Basaglar and Semglee are a Regular Benefit for patients covered under Plan W (First Nations Health Benefits).

Special Authority request form(s)