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    v1.0.30
    OpenPayerPolicy UpdatesPharmacy & Specialty DrugsOklahoma Health Care Authority PA | OpenPayer
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    CurrentOklahoma Health Care AuthorityPolicy N/A

    Glumetza and Fortamet Extended-Release Metformin Coverage Criteria

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    This policy governs prior authorization for Glumetza and Fortamet. Approval requires documentation that the member cannot take generic metformin extended-release formulations after slow titration.

    Policy Summary
    PayerOklahoma Health Care Authority
    PolicyGlumetza and Fortamet Extended-Release Metformin Coverage Criteria
    Policy CodePolicy N/A
    Change TypeAnnual reviewno material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionSubmit documentation showing inability to take generic metformin extended release after titration from 500 mg to 2,000 mg daily at two-week intervals.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    6FY 2009 members using Glumetza or Fortamet
    27FY 2009 claims for Glumetza or Fortamet
    $4,569.24FY 2009 total cost
    15FY 2009 prior authorization petitions
    No changesRecommendation
    Policy Summary
    PayerOklahoma Health Care Authority
    PolicyGlumetza and Fortamet Extended-Release Metformin Coverage Criteria
    Policy CodePolicy N/A
    Change TypeAnnual reviewno material changes
    Effective DateN/A
    Next Review DateN/A
    Key ActionSubmit documentation showing inability to take generic metformin extended release after titration from 500 mg to 2,000 mg daily at two-week intervals.
    SourceLink
    On This Page
    Coverage CriteriaGeneric Metformin ER DosePrior Authorization and Documentation RequirementsBackgroundGlumetza or Fortamet Initial AuthorizationRequired Generic Metformin ER Trial

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    Coverage Criteria

    Initial Therapy: Glumetza or Fortamet

    Approval for initial therapy with Glumetza or Fortamet requires clinical documentation that the member is unable to take other forms of generic metformin extended-release after appropriate slow titration.

    ALL of the following

    • The requested medication is Glumetza or Fortamet.
    • Clinical documentation demonstrates inability to take other forms of generic metformin ER after slow titration of 500 mg ER at 2-week intervals up to 2,000 mg daily.

    Generic Metformin ER Dose

    Generic metformin ER titration
    Starting dose500 mg extended-release (ER)
    Dose-increase intervalEvery 2 weeks
    Maximum daily dose2000 mg daily

    Prior Authorization and Documentation Requirements

    Prior Authorization

    Generic Metformin ER Trial Required

    Prior authorization approval is based on clinical documentation that the member cannot take other forms of generic metformin ER after completing the required slow titration.

    Step Therapy

    Complete Slow Titration

    Before requesting Glumetza® or Fortamet®, try and titrate generic metformin ER from 500 mg, increasing the dose at two-week intervals up to 2,000 mg daily as tolerated.

    Documentation Required

    Document Inability to Use Generic Metformin ER

    Submit clinical documentation of the member’s inability to use other forms of generic metformin ER after the required slow titration from 500 mg ER at two-week intervals up to 2,000 mg daily.

    Background

    Glumetza and Fortamet are branded extended-release metformin products. Before approval of either branded product, the policy requires documentation that the member cannot take other forms of generic metformin extended release following slow titration from 500 mg ER, with dose increases at 2-week intervals up to 2,000 mg daily.

    Glumetza or Fortamet Initial Authorization

    Glumetza or Fortamet Initial Authorization

    Approval is based on clinical documentation of inability to take generic metformin ER after the required titration.

    Initial branded metformin ER authorization: The member is unable to take other forms of generic metformin extended release after slow titration from 500 mg ER at 2-week intervals up to 2,000 mg daily.500 mg ER titrated every 2 weeks up to 2,000 mg daily

    Required Generic Metformin ER Trial

    StepRequired therapyDose and titrationCoverage status
    1Generic metformin extended releaseBegin at 500 mg ER; increase at 2-week intervals up to 2,000 mg dailyRequired before approval of Glumetza or Fortamet
    Denial Risk

    Insufficient Documentation May Result in Denial

    Approval may be denied when documentation does not establish inability to take other forms of generic metformin ER following the required trial and titration.