Health Net
Steglujan (ertugliflozin-sitagliptin)
Hormones : Drugs for Diabetes
  • Prior Authorization: Chorea in Huntington's Disease:
    Documented Diagnosis: Yes
    Duration: 1 year(s)

    Tardive Dyskinesia (TD):
    Documented Diagnosis: Yes
    Duration: 1 year(s)
    Reauthorization Required: Yes

  • Quantity Limit: 2 inhalers per 30 day(s).
  • 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)