Diagnosis: Type 1 Diabetes

Treatment: Afrezza 4 & 8 & 12UNIT IN POWD

The insurer denied Afrezza 4 & 8 & 12UNIT IN POWD. The denial was upheld.

This is a male patient with a history Type 1 diabetes mellitus (DM), and hypothyroidism.
He consulted an endocrinologist as he was interested in switching his current insulin medication Humalog to inhaled insulin called Afrezza. It was reported that the patient is using Omnipod insulin pump for his insulin administration and that he has not tried formulary alternatives yet.

The patient is using an Omnipod insulin pump. There is no additional support for the need for inhaled insulin on any kind.

The formulary drug is not likely to cause any adverse reactions. Inhaled insulin Afrezza is the only other ultra-fast-acting mealtime insulin. Afrezza and Fiasp have not been compared in a head-to-head study.

The formulary drug has not been ineffective based on the patient's clinical history. The patient's most recent A1c of 7.1 indicates good control of his blood sugars.

The requested drug is not expected to be more effective that the formulary drug. The patient's most recent A1c of 7.1 indicates good control of his blood sugars.

Ranamukha, S. et al. (2018), "Fiasp® (insulin aspart, Novo Nordisk) is a faster-acting injectable insulin formulation that is administered subcutaneously (SC) for blood glucose management. We hypothesized that intradermal (ID) administration could improve the pharmacokinetic profile of Fiasp® when compared to traditional SC injection."

The carrier's denial of Formulary Exception for Afrezza 4 & 8 & 12UNIT IN POWD is upheld.