Diagnosis: Type 2 Diabetes Without Complications
Treatment: Formulary exception for Metformin Hydrochloride ER 1000mg F Tab
The insurer denied the Formulary exception for Metformin Hydrochloride ER 1000mg F Tab
The denial is overturned.

The patient is a male diagnosed with T2DM (type 2 diabetes mellitus). This request is for Metformin Hydrochloride ER (extended release) 1000mg (milligrams) Tab. As reported, he has been on Metformin Hydrochloride ER (extended release) 1000mg (milligrams) Tab for approximately four years and has been well-controlled. The prior authorization form reports that the patient has tried formulary alternatives and had gastrointestinal upset.

Yes, the health plan should cover the Formulary exception for Metformin Hydrochloride ER (extended release) 1000mg (milligrams).
Metformin is still the best first-line medication for treating type 2 diabetes [1]. There are fewer adverse events and better compliance with extended release metformin [2, 3, 4, 5, 6, 7]. The request is for metformin ER (extended release). The patient is reported to have tried formulary alternatives and had an adverse reaction in the form of gastrointestinal upset. Given the fact that the patient had adverse events with the formulary alternatives, the health plan should cover the Formulary exception for Metformin Hydrochloride ER (extended release) 1000mg (milligrams).