Diagnosis: Type 2 diabetes, hypertension, and coronary artery disease.
Treatment: Pharmacy/ Prescription Drugs (Janumet).

The insurer denied Janumet. The health plan's determination is overturned in whole.

This is a male with type 2 diabetes, hypertension, and coronary artery disease. He has been on Humalog. He was on Lantus which he stopped due to hypoglycemia. He has tried and failed metformin. He was on Janumet in the past. He has tried and failed Jentadueto. Request for Janumet is under review.

The health plan's determination is overturned in whole.

The formulary alternatives will be or have been ineffective. The documentation indicates that the patient has tried and failed Jentadueto. It is not appropriate to have the patient trial Jentadueto in this clinical situation, as the patient has already tried and failed Jentadueto. Without Janumet, this patient is at risk of hyperglycemia, which can cause retinopathy, neuropathy, and nephropathy.