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Pg.pdf

DIABETES (1 of 2)
Metformin
CVS (State
Healthcare
Generic
(30 days)
(Evercare)
Glucophage
$14 (500mg)
metformin
(Walmart $4)
$ not avail
Glucophage XR metformin ER
(Walmart $4)
Metaglip
metformin/glipizide
Glucovance
metformin/glyburide
Sulfonylurea
CVS (State
Healthcare
Generic
(30 days)
(Evercare)
glimepiride
(Walmart $4)
Glucotrol
glipizide
(Walmart $4)
Glucotrol XL
glipizide ER
Micronase,
glyburide
(Walmart $4)
glyburide
$11 Generic
micronized
(Walmart $4)
TZD/Others
CVS (State
Healthcare
Generic
(30 days)
(Evercare)
ACTOplus
Bydureon
Janumet XR
Kombiglyze XR saxagliptin/metformin
AlohaCare: Actos, Duetact, ACTOplusmet - trial of metformin or metformin/combination drugs in last 60 days
HMSA Quest: Actos - recent 60d trial of metformin or sulfonylurea. Actoplus met and Duetact - recent 30d of Actos
AND metformin/glimepiride. Januvia/Janumet/XR - recent 60d trial of metformin and sulfonylurea
Highlighted -
- covered by all 6 plans
January 2014 v30 p. 11
DIABETES (2 of 2)
CVS (State
Costco $ Generic
Aloha employees
Healthcare
Generic
(10 ml vial)
(Evercare)
vial, pen vial, pen
vial, pen vial, pen
Humalog Mix
vial, pen
Humalog Mix
vial, pen
Humulin 70/30
NPH/reg mix
vial, pen
Humulin N
vial, pen
Humulin R
$207 vial,
Lantus (vial)
vial, pen
vial, pen
vial, pen
vial, pen
Novolin 70/30 NPH/reg mix (int/reg)
$ not avail
Novolin N
Novolin R
vial, pen
Novolog 70/30
vial, pen
*HMSA Quest. Insulins - says which which insulin is covered, but not if both vial and pen forms are covered.
Glucometers
Costco $ Generic
CVS (State
Healthcare
(10 ml vial)
(Evercare)
Accu-Chek Aviva Plus,
Accu-Chek Compact Plus
Bayer Breeze 2/
Bayer Contour
Freestyle Lite/
Freestyle Freedom Lite
One touch ultra
(Ultra 2 or Ultra mini)
Ohana - glucometer. Website and customer service both say accu-chek and freestyle covered, but pharmacists tell us onetouch
glucometer/lancets covered but NOT test strips.
**UHC Evercare: Covers Bayer Breeze/Contour glucometer. For One Touch & Accu-Chek, covers test strips but need to call manufacturers
directly for free glucometer. Accu-Chek - call 877-411-9833. One Touch - call 1-800-285-9814, order code 596UHC100. Covered test strips:
one-touch ultra test strips (50 or 100), One Touch Delica Lancets (used with One Touch Ultra 2 Meter), One Touch Ultrasoft lancets (used with
older One Touch Ultra Meters). Non-insulin diabetics allowed once daily testing only. No longer covers Bayer test strips.
***CVS State employees: Accu-Chek or One Touch glucometers- call 1-800-588-4456.
*Free glucometer from manufacturer : www.accu-chek.com, www.bayercontour.com, www.freestylepromise.com, www.onetouch.com January 2014 v30 p. 12

Source: http://www.prescribingguide.com/pdf/diabetes.pdf

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