Western Health Advantage
Ozempic (0.25 or 0.5 MG/DOSE) (semaglutide)
Hormones : Drugs for Diabetes
  • Step Therapy: Diabetes Type 2: GLP1 + Combo:
    ST Single Generic

  • Quantity Limit: 30 day supply per 1 fill(s).
  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Diabetes Type 2: GLP1 + Combo:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)