| Kaiser Foundation Health Plan Southern California |
| Steglatro (ertugliflozin) |
| Hormones : Drugs for Diabetes |
- Step Therapy: Chronic Kidney Disease:
ST Single Brand
- Prior Authorization: Chronic Heart Failure (CHF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Chronic Kidney Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
- Chronic Heart Failure (CHF):
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: No
Duration of Reauthorization: N/A
Chronic Kidney Disease:
Documented Diagnosis: Yes
Medical Test Required: Yes
Reauthorization Required: Yes
Duration of Reauthorization: Unspecified
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