Glumetza (metformin extended-release modified release, brand and generic) — United Healthcare

type 2 diabetes

Preferred products

Submission of article(s) published in peer-reviewed medical literature showing the requested drug is likely to be more efficacious for this patient than metformin extended-release (generic Glucophage XR)
AND History of ≥ 12 week trial of metformin extended-release (generic Glucophage XR)
AND Submission of medical records documenting either: (1) inadequate response to metformin extended-release (generic Glucophage XR) as evidenced by Hemoglobin A1c above goal OR (2) intolerance to metformin extended-release (generic Glucophage XR) unable to be resolved with attempts to minimize adverse effects (e.g. dose reduction)
AND History of ≥ 12 week trial of metformin osmotic extended-release (generic Fortamet)
AND Submission of medical records documenting either: (1) inadequate response to metformin osmotic extended-release (generic Fortamet) as evidenced by Hemoglobin A1c above goal OR (2) intolerance to metformin osmotic extended-release (generic Fortamet) unable to be resolved with attempts to minimize adverse effects (e.g. dose reduction)
AND History of ≥ 12 week trial of metformin immediate-release
AND Submission of medical records documenting either: (1) inadequate response to metformin immediate-release as evidenced by Hemoglobin A1c above goal OR (2) intolerance to metformin immediate-release unable to be resolved with attempts to minimize adverse effects (e.g. dose reduction)

12 months