Novolin N — Point32Health
diabetes mellitus
Preferred products
- Humalog
- Humalog Mix
- Humulin N
- Humulin R
- Humulin Mix
- Lyumjev
- Toujeo
- Lantus
Initial criteria
- Patient has tried and failed therapy with ALL comparable formulations of Humulin, Humalog, Lyumjev, Lantus, and Toujeo OR
- Patient has contraindication to ALL comparable formulations of Humulin, Humalog, Lyumjev, Lantus, and Toujeo OR
- Provider has indicated that the patient would be unable to utilize Humulin, Humalog, Lyumjev, Lantus, and Toujeo because of visual, physical, or functional impairment
Reauthorization criteria
- Provider has indicated that the patient has shown improvement or is stable on the requested medication
Approval duration
initial 12 months; reauth 24 months