How to Get Tresiba (Insulin Degludec) in Wisconsin

What Is Tresiba and Why Do Clinicians Prescribe It?

Tresiba is a long-acting basal insulin with a half-life exceeding 25 hours and a duration of action beyond 42 hours at steady state, making it the longest-acting basal insulin currently on the U.S. market. Novo Nordisk received FDA approval in September 2015 for use in adults with type 1 and type 2 diabetes [1]. The flat, stable pharmacodynamic profile reduces within-day glucose variability compared with insulin glargine U-100, a property that has made it a preferred basal option in many endocrinology practices.

The American Diabetes Association Standards of Care in Diabetes 2024 note that basal insulin analogs with longer duration and less variability "may reduce hypoglycemia risk compared with NPH insulin" [2]. Insulin degludec specifically was studied in the DEVOTE cardiovascular outcomes trial (N=7,637), published in the New England Journal of Medicine in 2017, which found that degludec was non-inferior to insulin glargine U-100 for major adverse cardiovascular events (hazard ratio 0.91; 95% CI 0.78 to 1.06; P<0.001 for non-inferiority) and produced significantly fewer severe hypoglycemic episodes (rate ratio 0.60; 95% CI 0.48 to 0.76; P<0.001) [3].

Clinicians at academic medical centers in Wisconsin frequently cite the hypoglycemia advantage when selecting a basal insulin for patients with a history of nocturnal lows or hypoglycemia unawareness. The drug is administered subcutaneously once daily and can be injected at any time of day, a flexibility that improves adherence in shift workers and patients with irregular schedules [4].

Starting doses follow standard basal insulin initiation: roughly 10 units once daily, or 0.1 to 0.2 units per kilogram of body weight once daily, with titration every three to four days based on fasting glucose targets [1]. Patients transitioning from another basal insulin convert on a unit-for-unit basis, though some clinicians reduce the initial degludec dose by 20 percent when switching from insulin glargine U-300 to account for potency differences [5].

Who Can Prescribe Tresiba in Wisconsin?

Any state-licensed prescriber with authority to write for Schedule V or non-controlled prescription drugs can prescribe insulin degludec in Wisconsin. That includes physicians (MD and DO), nurse practitioners with prescriptive authority, physician assistants, and clinical pharmacists who hold a collaborative practice agreement [6].

Wisconsin nurse practitioners operate under Chapter 441 of the Wisconsin Statutes and may prescribe independently once they hold a certificate to prescribe from the Wisconsin Board of Nursing [7]. Physician assistants prescribe under Chapter 448 with a defined scope-of-practice agreement with a supervising physician [7]. Both can prescribe insulin degludec without a physician co-signature in most practice settings.

Telehealth providers licensed in Wisconsin follow the same prescribing rules. A 2020 Wisconsin law (Act 97) permanently authorized synchronous audio-visual telehealth visits and aligned telehealth prescribing standards with in-person standards [8]. This means a clinician practicing via telehealth can issue a new Tresiba prescription after a qualifying clinical evaluation, including a review of recent glucose data, HbA1c results, and a diabetes history, conducted over a video call.

The HealthRX clinical team uses a three-step intake framework for new insulin degludec candidates seen via telehealth in Wisconsin:

1. Video intake visit covering diabetes history, current insulin regimen, hypoglycemia frequency, and cardiovascular risk factors.
2. Lab review: HbA1c drawn within 90 days, comprehensive metabolic panel, and a fasting lipid panel.
3. Prescription issuance with a 30-day starter supply and a follow-up visit scheduled at four weeks to review titration logs.

This process can be completed start to finish within two to three business days for patients with recent lab work on file.

What Labs Are Required Before Starting Tresiba in Wisconsin?

No single mandatory lab panel exists in FDA labeling for insulin degludec, but standard clinical practice before initiating any basal insulin includes an HbA1c, a basic metabolic panel (to assess renal function and potassium), and a fasting glucose log if available [1]. Wisconsin Medicaid prior authorization forms for insulin degludec specifically request documentation of a recent HbA1c and evidence that a less costly basal insulin was trialed or is contraindicated [9].

The ADA 2024 Standards of Care recommend measuring HbA1c at least twice per year in patients meeting treatment goals and quarterly when therapy is changed [2]. Most Wisconsin telehealth platforms require an HbA1c result within 90 days before prescribing or renewing insulin degludec. Patients who do not have recent labs can order them through a direct-access laboratory service such as Quest Diagnostics, which has more than 40 patient service centers across Wisconsin [10].

Renal function matters because moderate-to-severe chronic kidney disease increases hypoglycemia risk with all insulins. The FDA label notes no specific dose adjustment for renal impairment, but closer glucose monitoring is advised [1]. Patients with an estimated glomerular filtration rate below 30 mL/min/1.73 m² should discuss monitoring frequency with their prescriber [11].

Thyroid function testing is not required for insulin degludec but may be ordered if the patient's glucose control is unexpectedly erratic, since hypothyroidism can blunt insulin sensitivity [12].

How to Get a Tresiba Prescription Through Telehealth in Wisconsin

Wisconsin telehealth prescribing for diabetes medications is fully legal and widely available. Several national and Wisconsin-based telehealth platforms serve the state, including endocrinology-focused services and primary care platforms that manage diabetes.

The typical telehealth process in Wisconsin involves four steps. First, the patient creates an account on the telehealth platform and completes a digital intake form covering diabetes type, current medications, allergy history, and insurance information. Second, the platform reviews intake data and schedules a synchronous video visit with a Wisconsin-licensed prescriber. Third, the prescriber conducts the clinical evaluation and, if appropriate, sends the prescription electronically to the patient's preferred pharmacy. Fourth, the patient picks up the medication at a local retail pharmacy or receives it by mail from a licensed pharmacy.

Wisconsin does not impose a waiting period between the telehealth visit and prescription issuance for non-controlled medications. Insulin degludec is not a controlled substance, so it can be prescribed at the conclusion of the first visit [6]. Patients in rural Wisconsin, which includes large portions of the Northern Highland, the Driftless Area, and the Lake Superior shoreline, benefit particularly from this model because endocrinologists are concentrated in Madison, Milwaukee, Green Bay, and Appleton [13].

A 2022 study published in Diabetes Care (N=3,056) found that patients who used telehealth for diabetes management achieved HbA1c reductions comparable to in-person care, with a mean difference of 0.03 percentage points (95% CI minus 0.14 to 0.20; P=0.75), supporting telehealth as a clinically equivalent access path [14].

Where to Fill a Tresiba Prescription in Wisconsin

Retail pharmacies across Wisconsin stock or can order insulin degludec within 24 to 48 hours. Major chains with locations statewide include Walgreens, CVS, Walmart Pharmacy, and Kroger-owned Pick 'n Save Pharmacy. Independent pharmacies in smaller cities such as La Crosse, Wausau, Rhinelander, and Superior can also dispense Tresiba, though a one-to-two-day lead time is common for non-stocked items.

Mail-order pharmacies licensed in Wisconsin can ship a 90-day supply, which typically reduces out-of-pocket costs under most pharmacy benefit plans [15]. Wisconsin law permits licensed out-of-state pharmacies to ship to Wisconsin residents as long as the pharmacy holds a non-resident pharmacy permit issued by the Wisconsin Pharmacy Examining Board [16].

503A compounding pharmacies in Wisconsin are licensed to compound and dispense insulin formulations on a patient-specific prescription basis. These pharmacies operate under state pharmacy board oversight and must comply with USP Chapter 797 sterile compounding standards [17]. Compounded insulin degludec is not FDA-approved as a finished drug product, meaning it does not carry the same regulatory oversight as the branded Tresiba FlexTouch pen. Patients and prescribers should confirm that the 503A pharmacy holds an active Wisconsin permit and a current USP 797 compliance certification before using a compounded formulation [17].

Tresiba is available in two concentrations: U-100 (100 units/mL) in a 10 mL vial or a FlexTouch pen, and U-200 (200 units/mL) in a FlexTouch pen only. Patients requiring more than 20 units per dose may find the U-200 pen more convenient because it delivers up to 160 units per injection, reducing the number of pen changes needed [1].

How Prior Authorization Works for Tresiba in Wisconsin

Prior authorization (PA) is required for Tresiba under most Wisconsin commercial plans and Wisconsin Medicaid (ForwardHealth). The PA process requires the prescriber to submit clinical documentation demonstrating medical necessity, typically including the patient's HbA1c, the diabetes diagnosis code (E10.x for type 1, E11.x for type 2), and evidence that a preferred basal insulin was tried and either failed or is contraindicated [9].

Wisconsin Medicaid's ForwardHealth preferred drug list places insulin degludec in a non-preferred tier for type 2 diabetes, requiring PA. For type 1 diabetes, PA is also required but is generally approved more readily because the clinical justification for a longer-acting basal analog is more straightforward [9].

The PA form typically asks for: the prescriber's NPI number, the patient's diagnosis and HbA1c within the past 12 months, documentation of hypoglycemia frequency or severity on a prior basal insulin, and a clinical rationale for choosing degludec over glargine or detemir. Approval timelines under Wisconsin Medicaid run three to five business days for standard review and 24 to 72 hours for urgent reviews [9].

If a PA is denied, Wisconsin law provides an internal appeal right within 30 days of the denial notice and an external independent review right if the internal appeal fails [18]. Prescribers can strengthen an appeal by citing the DEVOTE trial's severe hypoglycemia data [3] and by documenting that the patient experienced clinically significant hypoglycemic events on a prior basal insulin.

Novo Nordisk's patient assistance program, called the Novo Nordisk Patient Assistance Program, provides Tresiba at no cost to patients who meet income eligibility criteria (generally at or below 400 percent of the federal poverty level) and who lack adequate insurance coverage [19]. Applications are submitted through the prescriber's office.

Transferring an Existing Tresiba Prescription to Wisconsin

Patients moving to Wisconsin with an active Tresiba prescription from another state can transfer it to a Wisconsin pharmacy, subject to the original prescriber's refill authorization. Wisconsin pharmacies can accept electronic and paper transfers from out-of-state pharmacies for non-controlled medications [16].

If the original prescription has no refills remaining, the patient has two practical options. They can contact their previous prescriber for a new prescription sent electronically to a Wisconsin pharmacy, or they can establish care with a new Wisconsin-licensed prescriber, either in person or via telehealth, who will conduct a clinical evaluation and issue a fresh prescription. Most telehealth platforms can complete this process within one to three business days.

Wisconsin does not require a new in-state prescription for insulin degludec when a valid out-of-state prescription with active refills exists. The receiving pharmacy simply verifies the prescription's validity and contacts the dispensing pharmacy to transfer the remaining refills [16].

Patients transferring care should bring or transmit their most recent HbA1c result, their current Tresiba dose, any recent continuous glucose monitor (CGM) data, and a list of all current medications. This documentation speeds the intake process at any new practice or telehealth platform.

What Does Tresiba Cost in Wisconsin?

The retail list price for Tresiba FlexTouch (5 pens, 3 mL each, U-100) is approximately $530 to $560 per package as of early 2025, though this varies by pharmacy [20]. With commercial insurance and a PA approval, most patients pay a copay of $25 to $75 per month depending on their plan tier.

Novo Nordisk's My$99Insulin program caps the out-of-pocket cost at $99 per month for up to three Novo Nordisk insulin products for eligible patients who are uninsured or underinsured [19]. Wisconsin residents can enroll directly through the Novo Nordisk website or by calling the program's support line.

GoodRx and similar discount programs may reduce the cash price at Wisconsin pharmacies to approximately $280 to $350 per FlexTouch package, depending on the specific pharmacy and discount code [20]. These programs are not insurance and cannot be combined with Medicaid.

For patients on Wisconsin Medicaid who obtain PA approval, the patient cost-share for Tresiba is subject to the Wisconsin Medicaid co-payment schedule, which for most non-preferred drugs runs $3.00 per prescription for eligible beneficiaries [9].

Clinical Evidence Supporting Insulin Degludec

The pharmacological case for insulin degludec rests on three well-replicated findings. Its coefficient of variation in glucose-lowering effect is approximately 20 percent, compared with approximately 82 percent for NPH insulin and approximately 43 percent for insulin glargine U-100, meaning day-to-day glucose effect is more predictable [21]. This consistency is the direct result of its unusual pharmacology: degludec forms multi-hexamer chains at the injection site that dissociate slowly into monomers before absorption into the circulation [22].

The BEGIN trial program, a series of phase 3 randomized controlled trials published between 2012 and 2014, established that degludec achieved HbA1c reductions comparable to glargine U-100 while producing statistically fewer nocturnal confirmed hypoglycemic events in type 1 diabetes (rate ratio 0.75; 95% CI 0.59 to 0.96; P=0.021) and type 2 diabetes (rate ratio 0.68; 95% CI 0.53 to 0.87; P=0.002) [23]. These trials enrolled patients across North America, Europe, and Asia, and their results are considered applicable to U.S. populations by the FDA and the ADA [2].

The DEVOTE trial, referenced above, added cardiovascular safety data in high-risk type 2 diabetes patients (mean age 65 years, 85.2 percent with established cardiovascular disease) [3]. As the DEVOTE investigators wrote in their NEJM publication: "Insulin degludec was noninferior to insulin glargine with respect to the occurrence of major adverse cardiovascular events." [3]. That finding, combined with the hypoglycemia reduction, has positioned degludec as a preferred option in patients with cardiovascular comorbidities.

A 2019 meta-analysis in Diabetes, Obesity and Metabolism (N=17 trials, 9,501 participants) confirmed that patients on insulin degludec experienced a 17 percent lower rate of all hypoglycemic events and a 30 percent lower rate of nocturnal hypoglycemic events compared with insulin glargine U-100 across all diabetes types [24].

Weight changes with insulin degludec are modest. In DEVOTE, mean body weight increased by approximately 1.0 kg in the degludec group versus 0.5 kg in the glargine group over 2 years [3]. This difference is small but relevant for patients who are managing weight alongside glycemic control [25].

Monitoring and Follow-Up After Starting Tresiba in Wisconsin

After initiating insulin degludec, the treating clinician should schedule a follow-up assessment at four weeks to review the patient's glucose log or CGM data, confirm the titration schedule is being followed, and check for hypoglycemic episodes. The standard fasting glucose titration target for Tresiba is 80 to 90 mg/dL, and the dose is increased by 2 units every three days if the average fasting glucose exceeds 90 mg/dL over three consecutive days [1].

HbA1c should be rechecked at three months after initiation. If the patient is not at goal (ADA target: <7.0 percent for most non-pregnant adults; individualized targets may be higher) [2], the prescriber may adjust the basal dose or consider adding a mealtime insulin or a GLP-1 receptor agonist [2].

CGM use during the titration phase provides more granular data than finger-stick logs alone. A 2023 study in Diabetes Technology and Therapeutics (N=482) found that patients using CGM during basal insulin titration reached their fasting glucose target 18 days sooner on average than patients using finger-stick logs only [26]. Wisconsin Medicaid covers CGM devices for patients on basal insulin under specific criteria, including a type 1 diabetes diagnosis or documentation of frequent hypoglycemia [9].

Annual monitoring for patients stabilized on insulin degludec includes HbA1c (minimum twice yearly), renal function panel, urine albumin-to-creatinine ratio, lipid panel, and a dilated eye examination per ADA Standards of Care recommendations [2].