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Some of you may have heard that carriers are declining coverage of prescriptions listed in their formulary that are typically prescribed for diabetics. One in particular that stands out is Victoza. Carriers are taking a stance during the pre- authorization process to deny the prescription if someone has not been diagnosed ‘diabetic’. Most doctors, as mentioned in the article below that was released 12/12/24, are prescribing these drugs to pre-diabetics.
The purpose of this article is to make sure when you are quoting someone that has a prescription list which includes one of these drugs, make sure to mention that you are aware, in writing or verbally, that 1) The carrier will require a prior authorization (In allegations we’ve received, that is ENOUGH by the carriers standard, to have the allegation not- founded) 2) Extra step that I encourage you to take – That you’ve been made aware carriers will only approve the prescription they are taking during the authorization process if they have been diagnosed as diabetic.
Informative Articles Just for Members
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