Exenatide (Byetta), Exenatide extended release (Bydureon, Bydureon BCise)

Exenatide (Byetta^®), Exenatide extended release (Bydureon^®, Bydureon BCise^®)

SELF ADMINISTRATION

Indications for Prior Authorization:

• Adjunctive therapy to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee:

• Treatment of Type 1 diabetes
• Treatment of ketoacidosis
• Appetite suppression or treatment of obesity

All of the following must be met as a condition(s) for coverage:

• Diagnosis of Type 2 diabetes confirmed by chart note documentation, AND
• Trial and failure of metformin
• DPP4 (dipeptidyl peptidase-4) inhibitors are not approvable with concurrent administration of GLP-1 (glucagon-like peptide-1) agonists
• Exenatide (Byetta®), Exenatide Extended-Release (Bydureon®, Bydureon BCise®), Liraglutide (Victoza®), Semaglutide (Ozempic®, Rybelsus®), Dulaglutide (Trulicity®) are the preferred agents

Dosing:

Exenatide (Byetta®)

• Initiate at 5 mcg SubQ twice a day within the 60 minute period before the morning and evening meals. If an inadequate response, then dose may be increased to 10 mcg twice a day after one month

Exenatide extended release (Bydureon®, Bydureon BCise®)

• Inject 2 mg SubQ every week

Approval: 

• 1 year