Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| 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 | |
| Dapagliflozin Propanediol Monohydrate | Forxiga | 10 mg | QD | $80 | BC / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
| 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 | |
| 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) | |
| Sitagliptin | Januvia | 100 mg | QD | $95 | BC / NIHB - SA | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
| Semaglutide | Ozempic | 1 mg SQ | Once weekly | $525 | 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 (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 |
| Rapid-acting insulin | Apidra | 100 U/ml | As dir | $75 | 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 | $100 | 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 |
| 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 |
| 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 |