Riomet — Medical Mutual

Initial criteria

• Patient is age ≥ 10 years; AND
• The prescribed medication is being used as an adjunct to diet and exercise to improve glycemic control; AND
• The patient is unable to swallow the oral tablet dose forms due to the following (a OR b): a. Dysphagia; OR b. The individual is between 10 to 12 years of age; AND
• Riomet is not prescribed based on patient preference or convenience; AND
• If brand Riomet oral solution is requested, the patient has tried and failed generic metformin oral solution

Reauthorization criteria

• Response to therapy is required for continuation of therapy

Approval duration

1 year initial, 1 year reauth