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

Last review date: July 30, 2020

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