Metformin programs, scored

Every program here prescribes metformin. The FDA approves it for one use, improving blood sugar control in type 2 diabetes, so prescribing it for healthy aging, weight or prediabetes is off-label: legal for a licensed prescriber, but not a use the FDA has reviewed.

Scores and order come from the full metformin and rapamycin lineup. Each plate is the one the program carries there, and the line under each name shows which drug and form it belongs to, so check that it's the metformin plan if the program also sells rapamycin.

Metformin has been sold in the US since 1995 and is made by many generic makers. The tablet itself is rarely what makes one program cost more than another. The visit, the membership and the lab work are.

So the question to ask each program is what its fee buys. Some plans are a prescription and a refill reminder. Others order baseline blood work, repeat it, and give you a clinician to message. On a cheap generic, that difference is most of the value.

Next, look at the form. Metformin comes as immediate-release and extended-release tablets. The label notes the extended-release form exists partly to ease stomach side effects, and a program should say which one it prescribes and why.

Last, check how the drug reaches you. Ask whether the program ships the tablets or sends the prescription to a pharmacy you choose, where the generic may be inexpensive on its own, and whether the plan price covers the tablets or only the care.

• Kidney function first. The label rules metformin out when kidney function (eGFR) is below 30, and calls for checking it before the first prescription and during treatment.
• Lactic acidosis. The boxed warning: rare, but postmarketing cases have been fatal. Risk rises with kidney or liver impairment, age 65 or older, contrast imaging, surgery and heavy drinking.
• Vitamin B12. In the label's 29-week trials, B12 fell below normal in about 7% of people taking metformin, so long-term users may need it checked.
• Stomach side effects. Diarrhea, nausea, gas and stomach discomfort are the most common, and they tend to come early.
• Low blood sugar. Rare on metformin alone, but the risk rises when it's combined with insulin or a sulfonylurea. Tell the program about every medicine you take.

Plates here run $25 to $162 a month at the starting price, with required fees added. The middle plate, $58, adds up to about $696 over a year by our math. The ends of the range sit about $1,644 a year apart.

Across every program we track, 10 list metformin at $25–$162 a month. The spread is wide for a generic pill, which tells you the plans sell very different amounts of care.

Ask about lab costs before you compare plates. A program that orders kidney function and B12 checks and bills them separately can cost more in month one than a higher plate that includes them.

On this band, each ten dollars off the monthly price is worth about 2.9 price points. The guide to getting a metformin prescription online walks through the intake.

1. Will you check my kidney function before I start, and how often after that?
2. Immediate-release or extended-release, and why that one for me?
3. Does the monthly price include the tablets, or can I fill the prescription at my own pharmacy?
4. Will you check my vitamin B12 if I stay on metformin for years?
5. I already take other medicines. Who reviews them for interactions?
6. What would make you tell me to stop?