Insulin, Long-Acting (Basaglar®)

SELF ADMINISTRATION - Injectable

The Preferred Medications are Lantus®, Toujeo® SoloStar®/Toujeo® Max SoloStar®, Levemir®, and Tresiba®

Indications for Prior Authorization:

  • Indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus.  Not recommended for treating diabetic ketoacidosis.

Patients must meet the following criteria for the indications above:

  • Patient has tried and failed at least 2 of the following preferred long-acting insulins:  Lantus®, Toujeo® SoloStar®/Toujeo® Max SoloStar®, Levemir®, Tresiba®, OR
  • Medical record documentation supports a medically appropriate reason why the preferred medications cannot be considered, OR
  • The above criteria is met and medical record documentation also includes that the patient is continuing therapy previously covered under prior insurance coverage.

Approval:

  • 1 year

 

 

Last review date: March 18, 2020

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