Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
---|---|---|---|---|---|---|---|---|
Rapid-acting insulin biosimilars | Admelog | 100 U/ml | As dir | $65 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Rapid-acting insulin biosimilars | Trurapi | 100 U/ml | As dir | $65 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Regular insulin | Novolin Toronto/Humulin R | 100 U/ml | As dir | $70 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Repaglinide | Gluconorm | 1 mg | TID | $40 | BC / NIHB - Covered | B Hypoglycemic Agents | Meglitinides | |
Canagliflozin | Invokana | 100 mg | QD | $295 | BC / NIHB - SA | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Dapagliflozin Propanediol Monohydrate | Forxiga | 10 mg | QD | $80 | BC / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Empagliflozin | Jardiance | 10 mg | QD | $290 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Gliclazide | Diamicron | 80 mg | BID | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Gliclazide MR | Diamicron MR | 30 mg MR | 2 QD | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Glyburide | Diabeta | 5 mg | BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Sitagliptin | Januvia | 100 mg | QD | $95 | BC / NIHB - SA | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Lixisenatide | Adlyxine | 0.02 mg SQ | QD | $405 | BC - NC / NIHB - Covered | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Semaglutide | Ozempic | 0.5 mg SQ | Once weekly | $720 | BC / NIHB - SA | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Liraglutide | Victoza | 1.2 mg SQ | QD | $730 | BC / NIHB - NC | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Liraglutide | Victoza | 1.8 mg SQ | QD | $1090 | BC / NIHB - NC | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Basal insulin (Degludec) | Tresiba | 100 U/ml | As dir | $135 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Basal insulin (Detemir) | Levemir | 100 U/ml | As dir | $140 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Basal insulin (Glargine) | Lantus | 100 U/ml | As dir | $120 | BC - NC / NIHB - SA |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Basal insulin (Glargine) | Toujeo | 300 U/ml | As dir | $115 | BC - NC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Basal insulin biosimilar (Glargine) | Basaglar | 100 U/ml | As dir | $100 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Long-acting insulin | Novolin NPH/Humulin N | 100 U/ml | As dir | $70 | BC / NIHB - Covered |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Rapid-acting insulin | Humalog | 100 U/ml | As dir | $95 | BC - NC / NIHB - SA |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Rapid-acting insulin | Novorapid | 100 U/ml | As dir | $85 | BC - NC / NIHB - SA |
Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively). |
B Hypoglycemic Agents | Insulin |
Metformin | Glucophage | 500 mg | 2 BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Biguanides | |
Metformin SR | Glumetza SR | 1000 mg | 2 QD | $290 | BC - NC / NIHB - SA | B Hypoglycemic Agents | Biguanides | |
Linagliptin | Trajenta | 5 mg | QD | $280 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Saxagliptin | Onglyza | 5 mg | QD | $165 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) |