Limited Use Note(s) |
INSULIN LISPRO100U/mL Inj Sol-Pref Pen 5x3mL Pk (Junior KwikPen)
Reason For Use Code | Clinical Criteria |
---|---|
642 | Patient established on therapy prior to March 31, 2023 who is or has become pregnant during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
LU Authorization Period: One period of up to 12 months | |
643 | Patient established on therapy prior to March 31, 2023 who is or becomes palliative requiring end-of-life care during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
LU Authorization Period: One period of up to 12 months |