metformin osmotic extended-release (generic Fortamet) — United Healthcare
type 2 diabetes
Preferred products
- metformin immediate-release (generic Glucophage)
- metformin extended-release (generic Glucophage XR)
Initial criteria
- 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 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)
Approval duration
12 months