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.
- 1 year
Last review date: March 18, 2020