Diabetes Value-Based Benefits Program
We're committed to providing members with access to safe and effective medicines.
This list of common generic and preferred brand diabetic medicines and supplies are those subject to a $0 copay if you’ve completed an annual assessment with the Care Management Plus Program. This list is subject to change. Sign in to view the most current covered drug list (formulary).
To contact the Care Management Plus team, call 1-888-621-5894 (option 2), weekdays, from 8 a.m. to 5 p.m., Eastern Time.
- Generic prescription drugs are shown in lower-case boldface type. Most generic drugs are followed by a reference brand drug in (parentheses).
- Reference brands may not themselves be covered. Some generic products have noreference brand.
- Brand prescription drugs are shown in all capital letters followed by the generic name.
- Generic medicines are available for many of the brand-name drugs listed though may not be available in all strengths.
DIABETES MEDICATIONS — INSULIN
- FIASP, insulin aspart (with niacinamide) inj 100 unit/ml
- FIASP FLEXTOUCH, insulin aspart (with niacinamide) sol pen-inj 100 unit/ml
- FIASP PENFILL, insulin aspart (with niacinamide) soln cartridge 100 unit/ml
- HUMULIN R U-500 (CONCENTRATED), insulin regular (human) inj 500 unit/ml
- HUMULIN R U-500 KWIKPEN, insulin regular (human) soln pen-injector 500 unit/ml
- INSULIN ASPART, insulin aspart inj 100 unit/ml
- INSULIN ASPART FLEXPEN, insulin aspart soln pen-injector 100 unit/ml
- INSULIN ASPART PENFILL, insulin aspart soln cartridge 100 unit/ml
- INSULIN ASPART PROTAMINE/, insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)
- INSULIN ASPART PROTAMINE/, insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)
- INSULIN LISPRO, insulin lispro inj 100 unit/ml
- INSULIN LISPRO KWIKPEN, insulin lispro soln peninjector 100 unit/ml (1 unit dial)
- LANTUS, insulin glargine inj 100 unit/ml LANTUS
- SOLOSTAR, insulin glargine soln peninjector 100 unit/ml
- LEVEMIR, insulin detemir inj 100 unit/ml
- LEVEMIR FLEXTOUCH, insulin detemir soln peninjector 100 unit/ml
- NOVOLIN N, insulin nph (human) (isophane) inj 100 unit/ml
- NOVOLIN N FLEXPEN, insulin nph (human) (isophane) susp pen-injector 100 unit/ml
- NOVOLIN N FLEXPEN RELION, insulin nph (human) (isophane) susp pen-injector 100 unit/ml
- NOVOLIN N RELION, insulin nph (human) (isophane) inj 100 unit/ml
- NOVOLIN R, insulin regular (human) inj 100 unit/ml
- NOVOLIN R FLEXPEN, insulin regular (human) soln peninjector 100 unit/ml
- NOVOLIN R FLEXPEN RELION, insulin regular (human) soln pen-injector 100 unit/ml
- NOVOLIN R RELION, insulin regular (human) inj 100 unit/ml
- NOVOLIN 70/30, insulin nph isophane & regular human inj 100 unit/ml (70-30)
- NOVOLIN 70/30 FLEXPEN, insulin nph & regular susp pen-inj 100 unit/ml (70-30)
- NOVOLIN 70/30
- FLEXPEN RELION, insulin nph & regular susp pen-inj 100 unit/ml (70-30)
- NOVOLIN 70/30 RELION, insulin nph isophane & regular human inj 100 unit/ml (70-30)
- NOVOLOG, insulin aspart inj 100 unit/ml NOVOLOG
- FLEXPEN, insulin aspart soln pen-injector 100 unit/ml
- NOVOLOG MIX 70/30, insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)
- NOVOLOG MIX 70/30 PREFILL, insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)
- NOVOLOG PENFILL, insulin aspart soln cartridge 100 unit/ml
- TOUJEO MAX SOLOSTAR, insulin glargine soln peninjector 300 unit/ml (2 unit dial)
- TOUJEO SOLOSTAR, insulin glargine soln peninjector 300 unit/ml (1 unit dial)
- TRESIBA, insulin degludec inj 100 unit/ml
- TRESIBA FLEXTOUCH, insulin degludec soln peninjector 100 unit/ml
- TRESIBA FLEXTOUCH, insulin degludec soln peninjector 200 unit/ml
DIABETES MEDICATIONS — INSULIN COMBINATIONS
- SOLIQUA 100/33, insulin glargine-lixisenatide sol pen-inj 100-33 unit-mcg/ml
- XULTOPHY 100/3.6, insulin degludec-liraglutide sol pen-inj 100-3.6 unit-mg/ml
DIABETES MEDICATIONS — ORAL
- acarbose tab 25 mg (Precose)
- acarbose tab 50 mg (Precose)
- acarbose tab 100 mg (Precose)
- FARXIGA, dapagliflozin propanediol tab 5 mg (base equivalent)
- FARXIGA, dapagliflozin propanediol tab 10 mg (base equivalent)
- glimepiride tab 1 mg (Amaryl)
- glimepiride tab 2 mg (Amaryl)
- glimepiride tab 4 mg (Amaryl)
- glipizide tab 5 mg (Glucotrol)
- glipizide tab 10 mg (Glucotrol)
- glipizide tab er 24hr 2.5 mg (Glucotrol xl)
- glipizide tab er 24hr 5 mg (Glucotrol xl)
- glipizide tab er 24hr 10 mg (Glucotrol xl)
- glipizide-metformin hcl tab 2.5-250 mg
- glipizide-metformin hcl tab 2.5-500 mg
- glipizide-metformin hcl tab 5-500 mg
- glyburide micronized tab 1.5 mg (Glynase)
- glyburide micronized tab 3 mg (Glynase)
- glyburide micronized tab 6 mg (Glynase)
- glyburide tab 1.25 mg
- glyburide tab 2.5 mg
- glyburide tab 5 mg
- glyburide-metformin tab 1.25-250 mg
- glyburide-metformin tab 2.5-500 mg
- glyburide-metformin tab 5-500 mg
- GLYXAMBI, empagliflozin-linagliptin tab 10-5 mg
- GLYXAMBI, empagliflozin-linagliptin tab 25-5 mg
- INVOKAMET, canagliflozin-metformin hcl tab 50-500 mg
- INVOKAMET, canagliflozin-metformin hcl tab 50- 1000 mg
- INVOKAMET, canagliflozin-metformin hcl tab 150- 500 mg
- INVOKAMET, canagliflozin-metformin hcl tab 150- 1000 mg
- INVOKAMET XR, canagliflozin-metformin hcl tab er 24hr 50-500 mg
- INVOKAMET XR, canagliflozin-metformin hcl tab er 24hr 50-1000 mg
- INVOKAMET XR, canagliflozin-metformin hcl tab er 24hr 150-500 mg
- INVOKAMET XR, canagliflozin-metformin hcl tab er 24hr 150-1000 mg
- INVOKANA, canagliflozin tab 100 mg
- INVOKANA, canagliflozin tab 300 mg
- JANUMET, sitagliptin-metformin hcl tab 50-500 mg
- JANUMET, sitagliptin-metformin hcl tab 50-1000 mg
- JANUMET XR, sitagliptin-metformin hcl tab er 24hr 50-500 mg
- JANUMET XR, sitagliptin-metformin hcl tab er 24hr 50-1000 mg
- JANUMET XR, sitagliptin-metformin hcl tab er 24hr 100-1000 mg
- JANUVIA, sitagliptin phosphate tab 25 mg (base equiv)
- JANUVIA, sitagliptin phosphate tab 50 mg (base equiv)
- JANUVIA, sitagliptin phosphate tab 100 mg (base equiv)
- JARDIANCE, empagliflozin tab 10 mg
- JARDIANCE, empagliflozin tab 25 mg
- metformin hcl oral soln 500 mg/5ml (Riomet)
- metformin hcl tab 500 mg
- metformin hcl tab 850 mg
- metformin hcl tab 1000 mg
- metformin hcl tab er 24hr 500 mg
- metformin hcl tab er 24hr 750 mg
- metformin hcl tab er 24hr modified release 500 mg (Glumetza)
- metformin hcl tab er 24hr modified release 1000 mg (Glumetza)
- metformin hcl tab er 24hr osmotic 500 mg (Fortamet)
- metformin hcl tab er 24hr osmotic 1000 mg (Fortamet)
- miglitol tab 25 mg (Glyset)
- miglitol tab 50 mg (Glyset)
- miglitol tab 100 mg (Glyset)
- nateglinide tab 60 mg (Starlix)
- nateglinide tab 120 mg (Starlix)
- pioglitazone hcl tab 15 mg (base equiv) (Actos)
- pioglitazone hcl tab 30 mg (base equiv) (Actos)
- pioglitazone hcl tab 45 mg (base equiv) (Actos)
- pioglitazone hcl-glimepiride tab 30-2 mg (Duetact)
- pioglitazone hcl-glimepiride tab 30-4 mg (Duetact)
- pioglitazone hcl-metformin hcl tab 15-500 mg (Actoplus met)
- pioglitazone hcl-metformin hcl tab 15-850 mg (Actoplus met)
- repaglinide tab 0.5 mg
- repaglinide tab 1 mg
- repaglinide tab 2 mg
- RYBELSUS, semaglutide tab 3 mg
- RYBELSUS, semaglutide tab 7 mg
- RYBELSUS, semaglutide tab 14 mg
- SYNJARDY, empagliflozin-metformin hcl tab 5- 500 mg
- SYNJARDY, empagliflozin-metformin hcl tab 5- 1000 mg
- SYNJARDY, empagliflozin-metformin hcl tab 12.5- 500 mg
- SYNJARDY, empagliflozin-metformin hcl tab 12.5- 1000 mg
- SYNJARDY XR, empagliflozin-metformin hcl tab er 24hr 5-1000 mg
- SYNJARDY XR, empagliflozin-metformin hcl tab er 24hr 10-1000 mg
- SYNJARDY XR, empagliflozin-metformin hcl tab er 24hr 12.5-1000 mg
- SYNJARDY XR, empagliflozin-metformin hcl tab er 24hr 25-1000 mg
- TOLBUTAMIDE, tolbutamide tab 500 mg
- TRIJARDY XR, empagliflozin-linaglip-metformin tab er 24hr 12.5-2.5-1000
- TRIJARDY XR, empagliflozin-linagliptin-metformin tab er 24hr 10-5-1000
- TRIJARDY XR, empagliflozin-linagliptin-metformin tab er 24hr 25-5-1000
- TRIJARDY XR, empagliflozin-linagliptin-metformin tab er 24hr 5-2.5-1000
- XIGDUO XR, dapagliflozin-metformin hcl tab er 24hr 2.5- 1000 mg
- XIGDUO XR, dapagliflozin-metformin hcl tab er 24hr 5- 500 mg
- XIGDUO XR, dapagliflozin-metformin hcl tab er 24hr 5- 1000 mg
- XIGDUO XR, dapagliflozin-metformin hcl tab er 24hr 10- 500 mg
- XIGDUO XR, dapagliflozin-metformin hcl tab er 24hr 10- 1000 mg
DIABETIC DEVICES — GLUCOSE METERS
- Blood Glucose Meter Disposable Device With Test Strips
- Blood Glucose Monitoring Devices
- Blood Glucose Monitoring Kit
- Blood Glucose Monitoring Kit W/ Device
DIABETIC SUPPLIES — COMPREHENSIVE
- Alcohol Prep Pads, Swabs
- Calibration Liquid
- Glucose Monitoring Sensor
- Insulin Syringes
- Lancet Devices
- Lancets
- Pen Needles
- Test Strips and Disks (acetone, blood glucose, urine glucose, blood and urine ketone)
