| Anti-Hypoglycemia |
·
glucagon (rDNA) for inj kit 1mg PROGLYCEM SUS
·
diazoxide susp 50mg/ml 2 Only two drugs in category Proglycem No
generic available
| Oral Hypoglycemics | |
| Alpha Glucosidase
Inhibitors |
·
acarbose Precose No generic
available
| Biguanides |
·
metformin Glucophage
| Meglitinides |
·
nateglinide Starlix No
generic available
| Sulfonylureas |
·
glipizide Glucatrol
·
glimepiride Amaryl No generic available
| Thiazolidinediones |
·
pioglitazone Actos No generic available
·
rosiglitazone maleate Avandia
No generic available
| Combination drugs |
·
glyburide/metformin Glucophage
·
rosiglitazone maleate/metformin Avandamet
·
glipizide/metformin Glucovance
| Insulins Insulin,
Rapid-acting |
·
insulin, human aspart
| Insulin, Short Acting |
·
insulin, human
| Insulin,
Intermediate-Acting |
·
insulin, human
| Insulin, Long-Acting |
· insulin, glargine
| Diabetic Supplies |
|
Syringes, Gauze Pads, and
alcohol swabs are covered as tier 2 drugs |
| MISC 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 |