Afrezza (insulin regular human) — Blue Cross Blue Shield of Montana
quantity limit exception
Initial criteria
- 1. The requested quantity (dose) does NOT exceed the program quantity limit OR 2. ALL of the following: A. The requested quantity (dose) exceeds the program quantity limit AND B. The requested quantity (dose) does NOT exceed the maximum FDA labeled dose AND C. The requested quantity (dose) cannot be achieved with a lower quantity of a higher strength that does NOT exceed the program quantity limit
Approval duration
12 months