Limited Coverage Drugs – Insulin Glargine

BIOSIMILARS INITIATIVE NOTICE

PharmaCare is changing coverage of insulin glargine products.

  • Patients currently using Lantus® must switch to Basaglar™ (in consultation with their prescriber) to maintain PharmaCare coverage.
  • Patients who are covered under Plan W (First Nations Health Benefits) and take Lantus are encouraged to switch to Basaglar; however, their Lantus coverage will not end on November 26, 2019.
  • Lantus patients who wish to maintain PharmaCare coverage must switch to Basaglar before November 26, 2019.  Both brands will be covered for patients with an existing SA for Lantus during the transition period beginning May 27, 2019 until November 25, 2019, after which Lantus coverage ends.
  • To maintain patients’ coverage, prescribers must write a new prescription for their Lantus patients, indicating the switch to Basaglar. The patient’s existing Basaglar SA remains in effect, indefinitely, and no new SA request is required.
  • For patients who are medically unable to switch, you can submit a new SA request for exceptional coverage of Lantus, which will be reviewed by Special Authority on a case-by-case basis. This request must be submitted before November 26, 2019 to ensure continued coverage.
  • Basaglar remains a Regular Benefit for patients covered under Plan W (First Nations Health Benefits).

 

Generic Name

insulin glargine

Strength

100 U/mL
Form

solution for injection

Basaglar

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.

Special Authority Request Form(s)