Clickable Table
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
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Glyburide | Diabeta | 5 mg | BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
Gliclazide MR | Diamicron MR | 30 mg MR | 2 QD | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
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) | |
Gliclazide | Diamicron | 80 mg | BID | $35 | BC / NIHB - Covered | B Hypoglycemic Agents | Sulfonylureas | |
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).
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Metformin | Glucophage | 500 mg | 2 BID | $25 | BC / NIHB - Covered | B Hypoglycemic Agents | Biguanides | |
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 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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Dapagliflozin Propanediol Monohydrate | Forxiga | 10 mg | QD | $80 | BC / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Basal insulin (Degludec) | Tresiba | 100 U/ml | As dir | $135 | 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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Linagliptin | Trajenta | 5 mg | QD | $280 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Liraglutide | Victoza | 1.8 mg SQ | QD | $1090 | BC / NIHB - NC | B Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Repaglinide | Gluconorm | 1 mg | TID | $40 | BC / NIHB - Covered | B Hypoglycemic Agents | Meglitinides | |
Metformin SR | Glumetza SR | 1000 mg | 2 QD | $290 | BC - NC / NIHB - SA | B Hypoglycemic Agents | Biguanides | |
Sitagliptin | Januvia | 100 mg | QD | $95 | BC / NIHB - SA | B Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Canagliflozin | Invokana | 100 mg | QD | $295 | BC / NIHB - SA | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
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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|
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).
|
|
Rapid-acting insulin | Novorapid | 100 U/ml | As dir | $85 | 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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Empagliflozin | Jardiance | 10 mg, 25 mg | QD | $290 | BC - SA / NIHB - Covered | B Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
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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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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