Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
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Empagliflozin | Jardiance | 10 mg, 25 mg | QD | $290 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Metformin | Glucophage | 500 mg | 2 BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Biguanides | |
Sitagliptin | Januvia | 100 mg | QD | $95 | BC / NIHB - SA | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Liraglutide | Victoza | 1.2 mg SQ | QD | $745 | BC / NIHB - NC | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Rapid-acting insulin | Novorapid | 100 U/ml | As dir | $90 | BC - NC / NIHB - SA | B Hypoglycemic Agents |
Insulin
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).
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Canagliflozin | Invokana | 100 mg | QD | $295 | BC / NIHB - SA | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Repaglinide | Gluconorm | 1 mg | TID | $40 | BC / NIHB - Covered | B Hypoglycemic Agents | Meglitinides | |
Liraglutide | Victoza | 1.8 mg SQ | QD | $1115 | BC / NIHB - NC | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Linagliptin | Trajenta | 5 mg | QD | $280 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Semaglutide | Ozempic | 1 mg SQ | Once weekly | $540 | BC / NIHB - SA | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Basal insulin (Glargine) | Toujeo | 300 U/ml | As dir | $115 | BC - NC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
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Gliclazide | Diamicron | 80 mg | BID | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Metformin SR | Glumetza SR | 1000 mg | 2 QD | $290 | BC - NC / NIHB - SA | B Hypoglycemic Agents | Biguanides | |
Rapid-acting insulin biosimilars | Trurapi | 100 U/ml | As dir | $65 | BC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
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Glyburide | Diabeta | 5 mg | BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Dapagliflozin Propanediol Monohydrate | Forxiga | 10 mg | QD | $80 | BC / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Basal insulin (Glargine) | Lantus | 100 U/ml | As dir | $120 | BC - NC / NIHB - SA | B Hypoglycemic Agents |
Insulin
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).
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|
Rapid-acting insulin | Apidra | 100 U/ml | As dir | $75 | BC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
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Gliclazide MR | Diamicron MR | 30 mg MR | 2 QD | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Basal insulin (Degludec) | Tresiba | 100 U/ml | As dir | $140 | BC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
|
|
Rapid-acting insulin | Humalog | 100 U/ml | As dir | $100 | BC - NC / NIHB - SA | B Hypoglycemic Agents |
Insulin
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).
|
|
Rapid-acting insulin biosimilars | Admelog | 100 U/ml | As dir | $65 | BC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
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|
Basal insulin biosimilar (Glargine) | Basaglar | 100 U/ml | As dir | $100 | BC / NIHB - Covered | B Hypoglycemic Agents |
Insulin
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).
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