Sutter Health Plus
Bydureon (exenatide microspheres)
Hormones : Drugs for Diabetes
  • Age Limit: This drug may require prior authorization if your age does not fall within manufacturer, FDA, or clinical recommendations. At least 6 years old
  • Step Therapy Exists in PA
  • Graft Versus Host Disease (GVHD), Secondary Progressive Multiple Sclerosis:
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Granulomatosis with Polyangiitis:
    Age Requirement: >= 2
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): IngenioRx Specialty Pharmacy
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Immune Thrombocytopenic Purpura (ITP):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Diagnosis Types: Immune Thrombocytopenic Purpura
    Required Medical Information: 2 of Documentation of diagnosis;Medication History
    Supporting Documentation Must Be Submitted: Yes

    Microscopic Polyangiitis (MPA):
    Age Requirement: >= 2
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Multiple Sclerosis (MS):
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    Patients Cardiac Medical History Required: No
    Concomitant use of other MS medication: No

    Myasthenia Gravis:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Pemphigus Vulgaris:
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialty Pharmacy Provider(s): IngenioRx Specialty Pharmacy
    Reauthorization Required: No
    Duration of Reauthorization: N/A

    Rheumatoid Arthritis (RA):
    Age Requirement: >= 18
    Duration: 1 year(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: No
    Duration of Reauthorization: N/A
    TB Test required: No