| 642 | Patient established on therapy prior to March 31, 2023 who is or has become pregnant during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
| | LU Authorization Period: One period of up to 12 months |
| 643 | Patient established on therapy prior to March 31, 2023 who is or becomes palliative requiring end-of-life care during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
| | LU Authorization Period: One period of up to 12 months |
| 646 | Patient uses an insulin pump that has not been declared compatible with a funded biosimilar version by the insulin pump manufacturer's product labeling. |
| | LU Authorization Period: 1 year |
