generic Glumetza (metformin 500 and 1,000 mg ER tablets) — Point32Health
type 2 diabetes mellitus (noninsulin dependent) when hyperglycemia cannot be managed with diet and exercise alone
Preferred products
- generic Glucophage XR (metformin ER)
- generic Fortamet (metformin ER)
Initial criteria
- Documentation from the provider that treatment with generic Glucophage XR (metformin ER) AND generic Fortamet (metformin ER) is clinically inappropriate
- For daily doses of 1,000 mg, in addition to the above criteria, documentation of clinical inappropriateness of treatment with two 500 mg generic Glucophage XR (metformin ER) tablets is required for approval