Medicare Part D
Covered with requirementsNo additional clinical requirements are listed beyond the diagnosis.
Qualification pathways
You can qualify through any one of these.
Type 2 Diabetes Mellitus
All of:
- Diagnosis of type 2 diabetes mellitus
Documentation to bring
- Documentation of type 2 diabetes mellitus diagnosis
Approval and renewal
- Initial approval: 12 months
- Renewal: every 12 months
Not covered when
- Use for weight loss is excluded
Policy note: Coverage duration is plan year. Prescriber restriction is licensed practitioner. Part B prerequisite is listed as 0. The document states the off-label use for weight loss is excluded. Only required medical information stated is a type 2 diabetes mellitus diagnosis; no A1C threshold, metformin step therapy, or other detailed criteria are specified.
Policy effective June 1, 2026 · verified June 2, 2026 · source: 2026%20Super%20National%205%20MAPD-Prior%20Authorizationpdf