Health Net
Trulicity (dulaglutide)
Hormones : Drugs for Diabetes
  • 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

  • Prior Authorization: Diabetes Type 2: GLP1 + Combo:
    Documented Diagnosis: Yes
    Medical Test Required: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

  • Step Therapy: Diabetes Type 2: GLP1 + Combo:
    ST Single Generic