Health Net
Soliqua (insulin glargine-lixisenatide)
Hormones : Drugs for Diabetes
  • Prior Authorization: Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Diabetes Type 2: Long Acting Insulin + Combo:
    ST Multiple Brands

  • Diabetes Type 2: GLP1 + Combo:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Supporting Documentation Requirements: 1 of Chart Notes;Lab Tests;Medication History

    Diabetes Type 2: Long Acting Insulin + Combo:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Reauthorization Required: Yes
    Duration of Reauthorization: = 6 month(s)
    Supporting Documentation Requirements: 3 of Chart Notes;Lab Tests;Medication History

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