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Aetna requires documented trial of metformin at a therapeutic dose (1,000 mg or higher daily) for at least 90 days with either inadequate A1C response or documented intolerance
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N Engl J Med 375:311–322 Ahrén B, Masmiquel L, Kumar H, Sargin M, Karsbøl JD, Jacobsen SH, Chow F (2017) Efficacy and safety of once-weekly semaglutide versus once-daily sitagliptin as an add-on to metformin, thiazolidinediones, or both, in patients with type 2 diabetes (SUSTAIN 2): a 56-week, double-blind, phase 3a, randomised trial
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