Byetta (exenatide) — Medica
Type 2 diabetes mellitus
Initial criteria
- Patient has a diagnosis of type 2 diabetes mellitus
- Medication is being requested for an FDA-approved indication
- Medication will not be used for the treatment or prevention of prediabetes, diabetes prevention, or metabolic syndrome in a patient who does not have type 2 diabetes
- Medication will not be used in combination with another GLP-1 receptor agonist or a GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonist
- Examples of drugs not to be combined include but are not limited to Saxenda (liraglutide), Wegovy (semaglutide), and Zepbound (tirzepatide)
Reauthorization criteria
- Patient continues to have type 2 diabetes mellitus
- Medication remains prescribed for an FDA-approved indication
- Patient is not using the medication in combination with another GLP-1 receptor agonist or GLP-1/GIP agonist