Glumetza (metformin modified release) — Blue Cross Blue Shield of Alabama
Adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus
Preferred products
- metformin osmotic ER (generic Fortamet ER)
- metformin ER (generic Glucophage XR)
Initial criteria
- Target agent will be approved when ONE of the following is met:
- • The requested agent is eligible for continuation of therapy AND ONE of the following:
- – The patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days OR
- – The prescriber states the patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed OR
- – The patient’s medication history includes use of ONE prerequisite agent in the past 90 days OR
- – The patient has an intolerance or hypersensitivity to ONE prerequisite agent that is not expected to occur with the requested agent OR
- – The patient has an FDA labeled contraindication to ALL prerequisite agents available that is not expected to occur with the requested agent
Approval duration
12 months