Diagnosis: Type 2 Diabetes.
Treatment: Invokamet XR, Pre-service.

The insurer denied the Invokamet XR (extended release).
The denial is overturned.

This is a male with type 2 diabetes. He has tried and failed Synjardy, due to stomach pain, and Xigduo, due to hyperglycemia. He is stable on Invokamet. Request for continuation of Invokamet is under review. The prior request for Invokamet was denied as the patient has not had a trial of Synjardy XR (extended release) and Xigduo XR (extended release). The attending physician is appealing this determination.

Yes, the health plan should cover the proposed treatment.

This patient has type 2 diabetes. He is stable on Invokamet. He has tried and failed Synjardy and Xigduo. Given he has tried and failed Synjardy, he can be expected to fail Synjardy XR (extended release). Given he has tried and failed Xigduo, he can be expected to fail Xigduo XR (extended release). Without Invokamet, this patient will be at risk of hyperglycemia, which can cause retinopathy, neuropathy, and nephropathy. Therefore, yes, the health plan should cover the proposed Invokamet. The recommend duration of treatment is 12 months.