Humalog Mix 50/50 — Blue Cross Blue Shield of Alabama

To improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus or type 2 diabetes mellitus

Preferred products

Non-preferred insulin agents will be approved when ONE of the following is met:
BOTH of the following:
• The requested agent is a rapid insulin
AND
• There is information that the patient is currently using an insulin pump that has an incompatibility with the preferred rapid insulin agent that is not expected to occur with the requested agent
OR
The request is for Humalog Mix 50/50 AND ONE of the following:
• The patient is currently using Humalog Mix 50/50 AND the prescriber states the patient is at risk if switched to a different insulin
OR
• The patient has tried and had an inadequate response to a preferred insulin mix
OR
BOTH of the following:
• The requested agent is a rapid, regular, mix, or NPH insulin
AND
ONE of the following:
• The patient has an intolerance or hypersensitivity to the preferred insulin agents of the same type (rapid or regular, mix or NPH) that is not expected to occur with the requested agent
OR
• The patient has an FDA-labeled contraindication to the generic equivalent that is not expected to occur with the requested agent
OR
• There is information that the patient has a physical or a mental disability that would prevent them from using a preferred insulin agent
OR
• The patient is pregnant

12 months