Sutter Health Plus
Steglujan (ertugliflozin-sitagliptin)
Hormones : Drugs for Diabetes
  • Crohn's Disease (CD):
    Age Requirement: >= 6
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

    Hidradenitis Suppurativa (HS):
    Age Requirement: >= 12
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Specialty Pharmacy Provider(s): CVS Specialty
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified

    Ulcerative Colitis (UC):
    Age Requirement: >= 5
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: Unspecified
    TB Test required: Yes

  • Prior Authorization: Diabetic Medical Supplies:
    Duration: 1 year(s)

  • Quantity Limit: 200 needles per 30 day(s).