![Pharmacology / Anti-diabetic drugs / Eli Lilly and Company / Pharmacist / Metformin / Insulin / Dapagliflozin / Pharmaceutical drug / Sulfonylurea / Medicine / Chemistry / Endocrine system Pharmacology / Anti-diabetic drugs / Eli Lilly and Company / Pharmacist / Metformin / Insulin / Dapagliflozin / Pharmaceutical drug / Sulfonylurea / Medicine / Chemistry / Endocrine system](https://www.pdfsearch.io/img/c1dc3cf09f820df2be7a4fca5561e43e.jpg) Date: 2014-08-07 16:26:15Pharmacology Anti-diabetic drugs Eli Lilly and Company Pharmacist Metformin Insulin Dapagliflozin Pharmaceutical drug Sulfonylurea Medicine Chemistry Endocrine system | | UTAH DEPARTMENT OF HEALTH, PRIOR AUTHORIZATION REQUEST FORM Sodium-Glucose Co-transporter 2 (SGLT-2) Inhibitors (canagliflozin, dapagliflozin)) Patient name:_____________________________________Medicaid ID #:__________
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