Sutter Health Plus
Ozempic (0.25 or 0.5 MG/DOSE) (semaglutide)
Hormones : Drugs for Diabetes
  • QL (1 per Rx);
  • Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes

  • PA_APPLIES
  • ST_APPLIES
  • Step Therapy: ST_APPLIES
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