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To avoid allegations of fiduciary breaches, it would be prudent for plan sponsors and third-party administrators (TPAs) to ensure that PBM formulary changes comply with plan terms and medical-necessity definitions

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Glucose-Lowering Therapy for People With Chronic Kidney Disease For individuals with type 2 diabetes and CKD, considerations for selection of glucose-lowering medications include their effectiveness and safety when eGFR is reduced as well as the potential to affect CKD progression, CVD risk, and hypoglycemia (140)