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Afrezza (insulin human)United Healthcare

Type 2 diabetes mellitus

Initial criteria

  • Diagnosis of type 1 diabetes mellitus AND used in combination with a basal insulin or continuous insulin pump OR diagnosis of type 2 diabetes mellitus
  • Patient is unable to self-inject medications (e.g. Humalog, Lantus, Toujeo) due to one of the following: physical impairment OR visual impairment OR lipohypertrophy OR documented needle-phobia to the degree that the patient has previously refused any injectable therapy or medical procedure (refer to DSM-5 for specific phobia diagnostic criteria)
  • FEV1 within the last 60 days is ≥70% of expected normal as determined by the physician
  • Patient does NOT smoke cigarettes
  • Patient has NOT recently quit smoking (within the past 6 months)
  • Patient does NOT have chronic lung disease (e.g. asthma, COPD)

Reauthorization criteria

  • Repeat pulmonary function test confirms that patient has NOT experienced a decline of 20% or more in FEV1
  • Patient continues to be unable to self-inject short-acting insulin due to one of the following: physical impairment OR visual impairment OR lipohypertrophy OR documented needle-phobia to the degree that the patient has previously refused any injectable therapy or medical procedure (refer to DSM-5 for specific phobia diagnostic criteria)
  • Patient continues to not smoke cigarettes

Approval duration

12 months