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The Policy VaultThe Policy Vault

Afrezza — Blue Cross Blue Shield of Alabama

diabetes mellitus type 2

Preferred products

  • Fiasp (insulin aspart)
  • Humalog (insulin lispro)
  • Humalog U200 (insulin lispro)
  • Lyumjev (insulin lispro-aabc)
  • NovoLog (insulin aspart)

Initial criteria

  • Diagnosis of diabetes mellitus type 1 AND patient is currently on long-acting insulin therapy OR diagnosis of diabetes mellitus type 2
  • Patient has received ALL of the following to identify any potential lung disease: detailed medical history review AND physical examination AND spirometry with Forced Expiratory Volume in 1 second (FEV1)
  • Patient has not smoked in the past 6 months
  • If the patient has an FDA labeled indication, then ONE of the following: patient’s age is within FDA labeling for the requested indication for the requested agent OR there is support for using the requested agent for the patient’s age for the requested indication
  • ONE of the following: patient has an intolerance or hypersensitivity to a preferred rapid acting insulin agent that is not expected to occur with the requested agent OR patient has an FDA labeled contraindication to a preferred rapid acting insulin agent