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Limited coverage criteria – insulin glargine

Last updated on March 18, 2025

 

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Generic name

 insulin glargine

Strength & form

 100 U/mL solution for injection

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

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

OR

  • 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

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

OR

  • 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

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