1. Blood Glucose Regulators   Costs
  2. bulletAnti-Hypoglycemia

·       glucagon (rDNA) for inj kit 1mg PROGLYCEM SUS

·       diazoxide susp 50mg/ml 2 Only two drugs in category Proglycem No generic available

    bulletOral Hypoglycemics
    bulletAlpha Glucosidase Inhibitors

·       acarbose  Precose No generic available

    bulletBiguanides

·       metformin  Glucophage

 

    bulletMeglitinides

·       nateglinide  Starlix No generic available

    bulletSulfonylureas

·       glipizide Glucatrol

·       glimepiride Amaryl No generic available

    bulletThiazolidinediones

·        pioglitazone  Actos No generic available

·       rosiglitazone maleate  Avandia No generic available

    bulletCombination drugs

·       glyburide/metformin Glucophage

·        rosiglitazone maleate/metformin Avandamet

·       glipizide/metformin Glucovance

    bulletInsulins Insulin, Rapid-acting

·       insulin, human aspart

    bulletInsulin, Short Acting

·        insulin, human

    bulletInsulin, Intermediate-Acting

·       insulin, human

    bulletInsulin, Long-Acting

·       insulin, glargine 

 

    bulletDiabetic Supplies    

Syringes, Gauze Pads, and alcohol swabs are covered as tier 2 drugs

    bulletMISC Diabetic Supplies

·       NOVOFINE syringes/needles

·       MEDISENSE SYRINGES syringes     

·       BD SYRINGES syringes         

·        SWABS

·       gauze pads   

ACETOHEXAMID TAB 250MG 0.6304
ACETOHEXAMID TAB 500MG 0.2246
ACETOHEXAMID TAB 500MG 1.1380
ACTOS        TAB 15MG 3.3275
ACTOS        TAB 30MG 5.3267
ACTOS        TAB 45MG 5.7780
AMARYL       TAB 1MG 0.3799
AMARYL       TAB 2MG 0.6157
AMARYL       TAB 4MG 1.1614
AVANDAMET    TAB 1-500MG 0.9069
AVANDAMET    TAB 2-1000MG 1.8138
AVANDAMET    TAB 2-500MG 1.3603
AVANDAMET    TAB 4-1000MG 2.7205
AVANDAMET    TAB 4-500MG 2.2167
AVANDIA      TAB 2MG 1.6417
AVANDIA      TAB 4MG 2.3438
AVANDIA      TAB 8MG 4.3415
BYETTA       INJ 5MCG 130.1563
CHLORPROPAM  TAB 100MG 0.1535
CHLORPROPAM  TAB 250MG 0.2815
DIABETA      TAB 1.25MG 0.2123
DIABETA      TAB 5MG 0.7624
DIABINESE    TAB 100MG 0.4408
DIABINESE    TAB 250MG 0.9315
FORTAMET     TAB 1000MG 2.0896
FORTAMET     TAB 500MG 0.8854
GLIPIZIDE    TAB 10MG 0.1089
GLIPIZIDE    TAB 5MG 0.0892
GLIPIZIDE ER TAB 10MG 0.6033
GLIPIZIDE ER TAB 2.5MG 0.3050
GLIPIZIDE ER TAB 5MG 0.2531
GLUCAGEN     INJ 1MG 63.2060
GLUCAGEN     INJ 1MG 63.2086
GLUCAGON     KIT 1MG 73.7375
GLUCOPHAGE   TAB 1000MG 1.5652
GLUCOPHAGE   TAB 500MG 0.7599
GLUCOPHAGE   TAB 850MG 1.2917
GLUCOPHAGE   TAB XR 500MG 0.7756
GLUCOPHAGE   TAB XR 750MG 1.1635
GLUCOTROL    TAB 10MG 0.8088
GLUCOTROL    TAB 5MG 0.4406
GLUCOTROL XL TAB 10MG 0.8634
GLUCOTROL XL TAB 2.5MG 0.4358
GLUCOTROL XL TAB 5MG 0.4356
GLUCOVANCE   TAB 1.25/250 0.8377
GLUCOVANCE   TAB 2.5/500 0.9993
GLUCOVANCE   TAB 5/500MG 0.9993
GLYB/METFORM TAB 1.25/250 0.6461
GLYB/METFORM TAB 2.5/500 0.6684
GLYB/METFORM TAB 5/500MG 0.6684
GLYBURID MCR TAB 1.5MG 0.1250
GLYBURID MCR TAB 3MG 0.0700
GLYBURID MCR TAB 6MG 0.1900
GLYBURIDE    TAB 1.25MG 0.1274
GLYBURIDE    TAB 2.5MG 0.1043
GLYBURIDE    TAB 5MG 0.1379
GLYCRON      TAB 4.5MG 0.8373
GLYNASE      TAB 1.5MG 0.5658
GLYNASE      TAB 3MG 0.9565
GLYNASE      TAB 6MG 1.5083
GLYSET       TAB 100MG 0.8620
GLYSET       TAB 25MG 0.6646
GLYSET       TAB 50MG 0.7308
HUMALOG      INJ 100/ML 6.3939
HUMALOG MIX  SUS 75/25 6.3939
HUMULIN      INJ 50/50 2.4278
HUMULIN      INJ 70/30 2.4278
HUMULIN L    INJ U-100 2.4278
HUMULIN N    INJ U-100 2.4278
HUMULIN R    INJ U-100 2.2102
HUMULIN R    INJ U-500 7.5714
HUMULIN U    INJ U-100 2.4278
ILETIN II    INJ LENTE PK 4.0783
ILETIN II    INJ NPH PORK 4.0783
ILETIN II RG INJ U100PORK 4.0783
LANTUS       INJ 100/ML 5.6409
METAGLIP     TAB 2.5-250M 0.7829
METAGLIP     TAB 2.5-500M 0.9340
METAGLIP     TAB 5-500MG 0.9340
METFORMIN    TAB 1000MG 0.1790
METFORMIN    TAB 500MG 0.1357
METFORMIN    TAB 500MG ER 0.3000
METFORMIN    TAB 750MG ER 0.8978
METFORMIN    TAB 850MG 0.2623
MICRONASE    TAB 2.5MG 0.5802
NOVOLIN      INJ 70/30 2.4534
NOVOLIN 70/  INJ 30 INNLT 3.4820
NOVOLIN 70/  INJ 30 PNFIL 5.1799
NOVOLIN L    INJ U-100 2.1289
NOVOLIN N    INJ INNOLET 3.4267
NOVOLIN N    INJ PENFILL 5.1799
NOVOLIN N    INJ U-100 2.4534
NOVOLIN R    INJ INNOLET 3.1731
NOVOLIN R    INJ PENFILL 4.7204
NOVOLIN R    INJ U-100 2.2358
NOVOLOG      INJ 100/ML 5.4504
NOVOLOG MIX  INJ 70/30 5.6440
PRANDIN      TAB 0.5MG 1.0960
PRANDIN      TAB 1MG 1.0960
PRANDIN      TAB 2MG 1.0960
PRECOSE      TAB 100MG 0.7800
PRECOSE      TAB 25MG 0.6048
PRECOSE      TAB 50MG 0.6514
PROGLYCEM    SUS 50MG/ML 4.7339
RIOMET       SOL 0.1422
STARLIX      TAB 120MG 0.9778
STARLIX      TAB 60MG 0.9410
SYMLIN       INJ 0.6MG/ML 16.8946
TOLAZAMIDE   TAB 100MG 0.2775
TOLAZAMIDE   TAB 250MG 0.3263
TOLAZAMIDE   TAB 500MG 0.6325
TOLBUTAMIDE  TAB 500MG 0.0420
TOLBUTAMIDE  TAB 500MG 0.2406
TOLINASE     TAB 100MG 0.4323
TOLINASE     TAB 250MG 1.0073
VELOSULIN BR INJ 100U/ML 3.7128