This is a patient with a diagnosis of Type 2 diabetes and Obesity. Her recent body mass index (BMI) was 35.7. Her last Hb1c was 7.9% with a creatinine of 0.68. She is currently on Metformin extended release [ER] (MOD) 2000 milligrams (mg) daily, Basaglar Insulin, Glimepiride, and Invokana. She had tried and failed immediate-release Metformin due to gastrointestinal (GI) side effects. She also tried and failed generic Glucophage extended release (XR) and had G.I side effects.
Per the letter written by her provider, she has tried and failed generic Metformin ER and Fortamet due to G.I side effects. She has been on the requested medication per review of clinical documentation. The health plan's determination is overturned. The patient has tried and failed formulary drugs due to adverse effects in per review of the provided documentation. She has Type 2 diabetes and obesity. Some formulations of Extended-release Metformin preparations are seen to have more tolerability compared to immediate-release preparations. She had tried and failed formulary medications including Immediate release Metformin and Generic Extended-release Metformin but is unable to tolerate them and they were also less effective. She has been tolerating Glumetza well and it is medically necessary for her to continue therapy with the requested medication.