Limited Use Note(s)

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SEMAGLUTIDE0.68mg/mL Inj Sol - Pref Pen 3mL Pk
Reason For Use CodeClinical Criteria
667For the treatment of adult patients with type 2 diabetes when adequate glycemic control is not achieved on the maximum tolerated dose of metformin or where metformin is contraindicated or inappropriate. Semaglutide is not funded in combination with another glucagon-like peptide-1 receptor agonist (GLP-1 RA) or dipeptidyl peptidase-4 (DPP-4) inhibitor. Injectable semaglutide is not funded in combination with oral semaglutide. Coverage is only provided for one dosage format. Reimbursed dose: As per the product monograph
LU Authorization Period: Indefinite.