Xultophy — Point32Health
Type 2 Diabetes Mellitus
Initial criteria
- Patient has Type 2 Diabetes
- AND Patient is inadequately controlled on combination therapy with a long-acting insulin (e.g., Lantus, Toujeo, etc), and an incretin mimetic (e.g., Victoza, Byetta, Bydureon, Trulicity, Ozempic, Rybelsus, Mounjaro, etc)
Reauthorization criteria
- Patient has Type 2 Diabetes
- AND The patient has shown improvement or is stable on the requested medication
Approval duration
24 months