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
OR
|
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. The patient is 17 years of age or older. AND
OR
|
Indefinite |