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.