Afrezza

Drug - Afrezza® (insulin,human) [Sanofi-Aventis U.S. LLC]

January 2018

Therapeutic area - Insulins

Approval criteria - Type 1 diabetes mellitus

The patient or prescribing physician must meet all of the following criteria:

Patient has a diagnosis of type 1 diabetes mellitus
Patient must be 18 years of age or older
Treatment with a prandial insulin has been initiated for at least 90 days or a documented intolerance or contraindication exists to prandial insulin (documentation showing the intolerance or contraindication must be submitted with prior authorization request)
Prescribing physician must make a statement of anticipated benefit and defines when efficacy will be re-evaluated
Afrezza must be used concurrently with a basal insulin
Prescriber attests that the patient is a non-smoker or has stopped smoking for at least six months prior to request for Afrezza
Patient has a compelling medical reason that prohibits him or her from self-injecting. Dislike of injections is not sufficient
Patient must not have a history of underlying lung disease (asthma, COPD, lung cancer)

Patient or prescribing physician must meet all of the following criteria:

Patient has a diagnosis of type 2 diabetes mellitus
Patient must be 18 years of age or older
Patient must be on two or more oral hypoglycemic agents concurrently
Treatment with a prandial insulin has been initiated for at least 90 days or a documented intolerance or contraindication exists to prandial insulin (clinical notes documenting the intolerance or contraindication must be submitted with prior authorization request)
Prescribing physician must make a statement of anticipated benefit and defines when efficacy will be re-evaluated
Prescriber attests that the patient is a non-smoker or has stopped smoking for at least six months prior to request for Afrezza
Patient has a compelling medical reason that prohibits him or her from self-injecting. Dislike of injections is not sufficient

MHCP Provider Call Center 651-431-2700 or 800-366-5411