Anthem Blue Cross (HMO, PPO, EPO)
Lyumjev KwikPen (insulin lispro-aabc)
Hormones : Drugs for Diabetes
  • Prior Authorization: Diabetes Type 2: Short Acting Insulin (Meal-time):
    Documented Diagnosis: Yes
    Duration: 1 year(s)

  • Diabetes Type 2: Short Acting Insulin (Meal-time):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

  • Quantity Limit: limit maximum 30 mL PER 30 day(s)
  • Step Therapy: Diabetes Type 2: Short Acting Insulin (Meal-time):
    ST Multiple Generics

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