UnitedHealthcare
Trulicity (dulaglutide)
Hormones : Drugs for Diabetes
  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Duration: 12 Month(s)
    Reauthorization Required: Yes

  • Quantity Limit: 4 pens (2mL) per 28 days
  • Step Therapy: Diabetes Type 2: GLP1 + Combo:
    ST Single Generic

  • Diabetes Type 2: GLP1 + Combo:
    Duration: 12 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)
    Supporting Documentation Requirements: Medication History