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Employer health plans and ACA insurers that have opted to cover GLP1 drugs have largely adopted cost containment measures such as prior authorization, step therapy, mandatory lifestyle programs and formulary exclusions to manage the financial impact
However, data are lacking to back up their theory [48]
The most serious but rare complication is metformin-associated lactic acidosis (MALA), typically occurring in the setting of renal impairment and mechanistically linked to mitochondrial complex I inhibition (Graham et al., 2011
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