My insurance just changed from Blue Cross Blue Shield to United Health. With Blue Cross I had no issue getting my 500mg metformin ER x3 times daily filled Zero. I went to fill my prescription today and was told United Health will not cover Metformin ER. My policy shows it covers XR. My doctor is confused. What is difference.? Anyone know?l
I could be mistaken, but my understanding is that they are the same thing. Both “ER” and “XR” stand for extended-release.
Metformin is the generic name of the following brand-name medications: Prandimet, Glucophage, Riomet, Fortamet, and Glumetza.
thanks will let you know waiting for appeal to United Health
Virtually every insurance plan should cover both Metformin and Metformin ER/XR as a generic with the lowest co-pay. If you have a prescription written for a branded version (such as Glucophage), that may be rejected or only covered as a non-preferred or branded version.
I suspect your pharmacy just “messed up.” They didn’t look up the medication properly. You have basically two options. Have your pharmacy call up United Health and ask about coverage for Metformin, in which case they will probably be called a “bozo” for not knowing the simplest thing about the most common diabetes medication. The other option is to walk down to Walmart where Metformin ER 500 mg is on the $4/month or $10/3 month list. You can get a 90 days supply of Metformin 500 mg (tid) for $30. For many of us, that is lower than our co-pay and you don’t even have to pay a higher cost only to be hassled by your insurance.
Thank you. I think I located issue. I found that only lupin brand generic metformin ER does not upset my stomach. I discovered this when cvs switched generics without telling me. I found a local pharmacy that could get lupin as opposed to teva or ameal (sp)? My local pharmacy is claiming that the lupin generic is 600 plus $ and won’t cover it for a 30 day supply. I remember the teva imparticular made me sick to my stomach. Anyone else have brand specific issues with metformin er? I’ll try the teva again and that is at cvs and Walmart
Thank you for your quick response , Brian
That should read united health won’t cover the 600$ the local pharmacy claims to charge. Again. Blue cross always covered it. BTW. I took the teva last night. My bg this morning was 85. Also on once a week trulicity. I like it.
Anyone else have brand specific reactions to generic metformin Tena ( teva) ameal. Lupin etc?
One last post sorry. The pill that I took last night that did not upset my stomach was made by sun pharmaceuticals. Metformin er
Good luck,insurance issues drive me crazy. Nancy
Well. Here is where we are at. I am fortunate to have a high functioning endo office. Office manager and pharmacy clArified to this point. While my prescription is a generic for Fortamet, a branded drug, Lupin the manufacturer has patented their generic version. Which explains price. Which explains possibly why united health is balking. However. Nurse says while patenting generic is ethically questionable it is not illegal. My vial says generic substituted for Fortamet. But they priced what they wanted. Office is writing letter of appeal to united health Nurse says other generic drugs have done the same thing.
This is extremely confusing. Generic medications become available after patent protection ends as manufacturers apply supply the same chemical equivalent as the original patented medication. If the generic is “patented” then it is protected by a patent and cannot either be a generic or legally have generics sold in the market (as these would violate the patent protection).
I will let you know what the conclusion is. I have no where near the background you have on this. It appears they are substituting Fortamet with their own Fortamet That is the best understanding I have. I was under the impression I was on a generic and this was supposedly what cvs handed out as a generic at one point. The endo nurse did say she saw this happen with one other generic drug but she couldn’t recall the name. I was on this drug to begin with because blue cross blue shield would not cover brand. So someone viewed this as a generic and covered it as such. This is lupin brand. If I cannot get it covered I will deal with with whichever generic I can get. Not paying h 6oo$. per month. Weirdly enough, They cover trulicity which is quite pricey
I suppose it is possible I was on brand Fortamet and did not realize it but my vial does say substituted for Fortamet. Thank you for following my saga. Will fill you in as I understand. You
Does this link to a press release work ? It basically states lupin has its own fda approval for this drug. Let me know if link works or I will resend
This is an announcement by Lupin that the FDA has granted them conditional approval for a generic metformin
Right. So it’s a generic. So. Will have to figure out why I am bring declined coverage and charged so much. Still
Have you tried looking up the UHC formulary online? It should list the specific medications covered, both brand & generic.
I get regular metformin as I do not have script coverage. I am from Michigan and we have a shopping chain Meijer that gives out this prescription free to all!
Shop Rite in the northeast does as well
I get my metformin er and cholesterol pills free from a chain grocery/all purpose store called Meijer. I get my bipolar Seroquel xr free from ax and me as I am under their income level and am on disability since 2010. The prior med Abilify helped cause diabetes, but it also runs in the family
I was wondering your outcome. I am on Metformin ER 500mg 2x a day. I am not diabetic. I have been on this for years (probably 10+) for PCOS.
Well, I tried to refill my prescription on Friday, 1/6/17, and WALGREENS said it was no longer covered. I called United Healthcare today and they confirmed that it is no longer covered. The rep lapsed into a long explanation that made no sense to me at the time, until, I read your post this evening. The rep did mention to me that I was receiving the fortamet (?) version of Metformin, and, I would need to switch to glucophage. That made no sense that the generic wasn’t covered, but, the name-brand was.
I looked at my bottle and indeed the manufacturer is lupin. I remember mentioning, to my new doctor, how sick I had been feeling on the metformin- to the point that I stopped taking it. All of a sudden, this past script, wasn’t making me ill. Now, it all makes sense- why, and, why it’s not being covered.
My other issue, which, I find to be extremely unethical- is that United Healthcare’s prescription coverage is Caremark. Which, is the CVS brand. When, you call the prescription line, they actually answer “CVS Caremark”! I can’t understand how it’s legal for a store (pharmacy) conglomerate to be the supplier/insurance and the pharmacy- to have the ability to set prices, control what’s available and covered, and, to whom. It just seems so unethical- I just can’t think of a better word to describe it.
When, I first was aware of this… I asked United Healthcare if there would be a change in service, since, CVS was now our prescription insurance- basically. They said “No”, BUT, I can tell you… on more than one occasion- I was sent from Walgreens to CVS, because, for one reason or another the prescription needed to be filled by CVS. Shocking coincidence… right?
Then today, the rep, not- so subtly suggested that I should consider switching to CVS for my prescription needs, because, they know what’s covered and this sort of thing wouldn’t happen. Really? That just doesn’t sit right with me!