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SoonerSelect enrollment is open through June 13! It’s your chance to pick or change your health and dental plans. Make changes in the member portal or call 800-987-7767.

Diabetic Medications

PHARM-13 Statement of Medical Necessity for Quantity Limits Override.

Diabetic Medications

Drugs

Quantity Limits

Byetta (Exenatide)  Sub-Q Pen Injector                   

 5mcg/0.02ml -- 3.6 mls per 90 Days                                    10mcg/0.04ml -- 7.2 mls per 90 Days

Insulin Assorted Vial 

 40 mls per 30 Days 

Insulin Assorted Pen Injectors and Cartridges

 45 mls per 30 Days

 

Last Modified on Nov 17, 2020
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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.