It is quite possible that when you mentioned to your doctor that you were not tolerating geneic metformin, your doctor changed you to a specific “branded” version, namely Fortamet . At least on one UHC list I found lists generic metformin as a “tier 1” drug. But Fortamet is a “tier 4” which is a “Unique and/or very high-cost drug.” It is even worse than a non-preferred branded drug.
You have some options. You can have your doctor rewrite your prescription for generic Metformin ER and get it filled and covered, likely without a problem. You can inquire with your insurance plan on what “branded” versions of Metformin are covered in tiers 1, 2 or 3. You might find that Glucophage for instance is tolerated better and is tier 3. Or finally, you can have your doctor write a letter of medical necessity saying you cannot tolerate the formulation of generic Metformin but can tolerate Fortamet and ask for an exception on the tiering (i.e. ask that it be covered as tier 3, non-preferred branded).
The same thing happened to me at CVS with UnitedHealth. Metformin ER isn’t covered. I called the prescription hotline number on the back of my insurance card, and get this, they said I can get the doctor to prescribe Glucophage or transfer my prescription to Walmart and pay $4! I’m like WTF…
Good thing I had one refill left of my previous Metformin to cover me.
Natalie
My apologies for this very long response time. I will try and briefly update
United Health refused to cover my brand specific metformin. Described on my prescription label as
Metformin OSM ER 500 mg Lup
Even at Sam’s Club the cost remains above 600$
The pharmacist at Sam’s club guesses that Lupin considers their formulation not generic and is able to charge accordingly. She also said maybe because it is an osmotic, which I have been meaning to google.
Then United Health refused to cover my Trulicity which bc bs had covered no questions asked. They said I needed to go through the step processes of starting with victoza etc and work my way up if that did not work. I have never been on victoza. Ever.
The insurance company was literally dictating my care above the doctor
I asked my endo to write a letter requesting the Trulicity. They wanted to charge me for the letter. His practice is going concierge, meaning he will offer better services for those who pay a fee, but that discussion is for another topic. I paid the doctor the fee, his nurse wrote a letter to United HeAlth and they agreed to cover Trulicity but only after my 3500$ deductible was met. So I’m still basically paying out of pocket for 6 months worth of Trulicity anyway. I still find it very effective with morning bg in the 70s and 80s.
I am very very fortunate to be able to cover these drugs at this time and I understand that. I am paying for insurance that will not cover my medical needs and then paying out of pocket. It is insane
I keep thinking that if I loose more weight I can get more control and maybe drop the Trulicity.
Does anyone have any experience with victoza and then Trulicity. I have no interest in a daily injection, but I do know there continues to be some concern with some long term impact of Trulicity and tumor growth. Etc. my endo says the studies are flawed and not to worry. However he also generally does not favor insulin for his type 2 s and I know this is Controversial as well.
Have covered many topics here Will try and post separate question on victoza v Trulicity
Would appreciate anyone’s input
Thank you
Both my husband and I have run into this problem with UHC. Our prescriptions aren’t for any specific brand, just generic Metformin ER. We are “highly encouraged” to use their mail order pharmacy Optum… by charging us quite a bit more if we fill at the local pharmacy.
Since switching to UHC in 8/2016, I have only just this month managed to get Optum to fill my metformin prescription. Instead having to fill at the corner store with a hefty co-pay. It required multiple letters from my endo and no one has ever been able to explain the problem. No one suggested changing the prescription to some other brand. But after 3 letters, they are finally shipping it to me at no co-pay.
. At least on one UHC list I found lists generic metformin as a “tier 1” drug. But Fortamet 