Apidra Solostar — Blue Cross Blue Shield of Alabama

Preferred products

• Fiasp (insulin aspart)
• Humalog (insulin lispro)
• Humalog U200 (insulin lispro)
• Lyumjev (insulin lispro-aabc)
• NovoLog (insulin aspart)
• Admelog (insulin lispro)
• Humulin R U-100 (regular human insulin)
• Novolin R (regular human insulin)
• Humulin N (human insulin isophane suspension)
• Novolin N (human insulin NPH)
• Humalog 75/25 (75% insulin lispro protamine suspension/25% insulin lispro)
• Humalog 50/50 (50% insulin lispro protamine suspension/50% insulin lispro)
• Humulin 70/30 (70% human insulin isophane suspension/30% human insulin)
• Novolin 70/30 (70% human insulin isophane suspension/30% human insulin)
• NovoLog 70/30 (70% insulin aspart protamine/30% insulin aspart)

Initial criteria

• Non-Preferred Insulin Target Agent(s) will be approved when ONE of the following is met:
• BOTH of the following:
• • The requested agent is a rapid insulin AND ONE of the following:
• – The patient is currently using an insulin pump that has an incompatibility with ALL preferred rapid insulin agents that is not expected to occur with the requested agent OR
• – The patient has tried and had an inadequate response to ALL preferred rapid acting insulin agents that is not expected to occur with the requested agent OR
• – The patient has an intolerance or hypersensitivity to ALL preferred rapid acting insulin agents that is not expected to occur with the requested agent OR
• – The patient has an FDA labeled contraindication to ALL preferred rapid acting insulin agents that is not expected to occur with the requested agent
• OR BOTH of the following:
• • The requested agent is a regular insulin AND ONE of the following:
• – The patient has tried and had an inadequate response to ALL preferred regular insulin agents that is not expected to occur with the requested agent OR
• – The patient has an intolerance or hypersensitivity to ALL preferred regular insulin agents that is not expected to occur with the requested agent OR
• – The patient has an FDA labeled contraindication to ALL preferred regular insulin agents that is not expected to occur with the requested agent
• OR BOTH of the following:
• • The requested agent is a mixed insulin AND ONE of the following:
• – The patient has tried and had an inadequate response to ALL preferred mixed insulin agents that is not expected to occur with the requested agent OR
• – The patient has an intolerance or hypersensitivity to ALL preferred mixed insulin agents that is not expected to occur with the requested agent OR
• – The patient has an FDA labeled contraindication to ALL preferred mixed insulin agents that is not expected to occur with the requested agent
• OR The patient has a physical or a mental disability that would prevent them from using ALL preferred insulin agents
• OR The patient is pregnant

Approval duration

12 months