Insulin, Rapid-Acting (Novolog, Fiasp)

SELF ADMINISTRATION OR OFFICE ADMINISTRATION - INJECTABLE

The Preferred Medication is Humalog

Indications for Prior Authorization:

  • Novolog: Indicated to improve glycemic control in adults and children with diabetes mellitus
  • Fiasp: Indicated to improve glycemic control in adults with diabetes mellitus

Patients must meet the following criteria for the indications above:

  • Patients have tried and failed preferred Humalog, OR
  • Medical record documentation supports a medically appropriate reason why Humalog cannot be considered, AND
  • For Fiasp: patient is 18 years or older

Approval:

  • 1 year