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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2016

Prior Authorization Required for Glumetza


Effective April 1, Harvard Pilgrim will require prior authorization for coverage of the medication Glumetza — extended-release metformin indicated for the management of type 2 diabetes — on the commercial Premium and Value formularies.

Generic metformin ER (AB-rated generics for Fortamet and Glucophage XR) will continue to be covered without prior authorization, when clinically appropriate. When prescribing, keep in mind that your patients will pay a lower copay on all commercial formularies for the 500mg strength of generic metformin ER rather than for the 1,000mg strength, as the latter is a high-cost generic. To obtain prior authorization, providers must meet the requirements of the Glumetza Clinical Criteria, which state that the patient:

  • Has a diagnosis of type 2 diabetes mellitus
  • Has tried and failed therapy with immediate-release metformin
  • Has tried and failed therapy with another formulation of extended-release metformin at the equivalent requested dose of Glumetza within the past 6 months

Approvals will be valid for 12 months. To request prior authorization, please complete the Glumetza Medication Request Form and fax it to MedImpact Healthcare Systems at 888-807-6643. For more information, refer to the Pharmacy page on Harvard Pilgrim's provider website.

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