InPen — Medical Mutual

Initial criteria

• Patient is age ≥ 7 years OR is younger than 7 years of age and will be using InPen with adult supervision
• Patient will be using InPen with Humalog, Novolog, or Fiasp
• Patient will use U-100 insulin only
• Patient has access to a device with the ability to install and use the InPen app (e.g. smartphone, tablet, etc. with iOS 10 or later or Android 6 or later)
• Patient is able and willing to visit a healthcare provider regularly and test blood glucose levels as recommended by their provider

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year initial, 1 year reauth