Special Authority Criteria - Insulin detemir

Generic Name / Strength / Form
insulin detemir
Criteria Approval Period

Type 1 diabetes – Patient of any age

Patient has a diagnosis of Type 1 diabetes requiring insulin and is currently taking insulin NPH and/or pre-mix insulin daily at optimal dosing:

OR

Type 2 diabetes – Patients over 17 years of age only

Patient has a diagnosis of Type 2 diabetes requiring insulin and is currently taking insulin NPH and/or pre-mix insulin daily at optimal dosing:

AND

  1. Has experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management.

OR

  1. Has documented severe or continuing systemic or local allergic reaction to existing insulin (see Special Notes below).

Indefinite

Practitioner Exemptions

  • Endocrinologists

Special Notes

  • Specialists with experience in paediatric diabetes management may also have prescriptions covered for patients meeting the coverage criteria but are required to submit a Special Authority request.
  • For item #2 above, documentation of previous trials (i.e., specific insulin tried and patient's response) is required.

Special Authority Request Forms

General Special Authority Request. (PDF 132K)