Byetta® (exenatide)

Also includes:

Adlyxin® (lixisenatide)

Bydureon® (exenatide extended-release)

Ozempic® (semaglutide)

Tanzeum® (albiglutide)

Trulicity® (dulaglutide)

Victoza® (liraglutide)

Priority Health Medicaid no longer utilizes drug-specific prior authorization forms. Visit the Medicaid Approved Drug List (ADL) to find the new PA form and drug criteria document.

Go to Medicaid ADL