Presbyterian Health Plan Presbyterian Insurance Company, Inc.
Diabetes Medications List
“Cost” is based on the 2009 online Medi-Span pricing guide; “Average % Decrease in A1C” is based on Manufacturer product information. These prices are valid as of February 19, 2009 and are subject to change. MEDICATION
Glyburide Glyburide Glyburide Glyburide MCR Glyburide MCR Glyburide MCR
STRENGTH
1.25mg 2.5mg 5mg 1.5mg 3mg 6mg
QUANTITY
100 100 100 100 100 100
COST
$12.44 $18.93* $28.31* $18.75 $21.75* $35.00*
COPAY
Generic Generic Generic Generic Generic Generic
AVERAGE % DECREASE IN A1C 1.5% 1.5% 1.5% 1.5% 1.5% 1.5% AVERAGE % DECREASE IN A1C 1.5% 1.5% 1.5% 1.5% 1.5% AVERAGE % DECREASE IN A1C 1.5% 1.5% 1.5% AVERAGE % DECREASE IN A1C 1.5% 1.5% 1.5% 1.5% 1.5% AVERAGE % DECREASE IN A1C 0.7%-1% 0.7%-1% 0.7%-1% AVERAGE % DECREASE IN A1C 0.7%-1% 0.7%-1% 0.7%-1%
0.7%-1% 0.7%-1% 0.7%-1%
MEDICATION
Glipizide Glipizide Glipizide ER Glipizide ER Glipizide ER
STRENGTH
5mg 10mg 2.5mg 5mg 10mg
QUANTITY
100 100 100 100 100
COST
$ 6.99* $11.92* $32.53 $32.53 $32.53
COPAY
Generic Generic Generic Generic Generic
MEDICATION
Glimepiride Glimepiride Glimepiride
STRENGTH
1mg 2mg 4mg
QUANTITY
100 100 100
COST
$13.41* $21.74* $41.00*
COPAY
Generic Generic Generic
MEDICATION
Metformin Metformin Metformin Metformin XR Metformin XR
STRENGTH
500mg 850mg 1000mg 500mg 750mg
QUANTITY
100 100 100 100 100
COST
$35.57* $38.63* $45.97* $30.55* $94.99
COPAY
Generic Generic Generic Generic Generic
MEDICATION
Precose Precose Precose
STRENGTH
25mg 50mg 100mg
QUANTITY
100 100 100
COST
$101.06 $114.31 $130.31
COPAY
Brand Brand Brand
MEDICATION
Avandia Avandia Avandia Actos Actos Actos
STRENGTH
2mg 4mg 8mg 15mg 30mg 45mg
QUANTITY
100 100 100 100 100 100
COST
$275.93 $409.53 $744.13 $501.27 $766.00 $830.93
COPAY
Brand Brand Brand Brand Brand Brand
[PPC070901ML]
MEDICATION
Starlix Starlix Prandin Prandin
STRENGTH
60mg 120mg 1mg 2mg
QUANTITY
100 100 100 100
COST
$184.70 $191.90 $202.23 $202.23
COPAY
Brand Brand Brand Brand
AVERAGE % DECREASE IN A1C 0.1%-0.7% 0.1%-0.7%
1.5% 1.5%
MEDICATION
Januvia Januvia Januvia
STRENGTH
25mg 50mg 100mg
QUANTITY
100 100 100
COST
$668.47 $668.43 $668.47
COPAY
Brand/PA** Brand/PA** Brand/PA**
AVERAGE % DECREASE IN A1C 0.6%-0.8% 0.6%-0.8% 0.6%-0.8% AVERAGE % DECREASE IN A1C 0.5%-1% 0.5%-1% AVERAGE % DECREASE IN A1C 1.5%-2.5% 1.5%-2.5% 1.5%-2.5%
1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5%
MEDICATION
Byetta Byetta
STRENGTH
5mcg 10mcg
QUANTITY
1.2ml 2.4ml
COST
$214.22 $282.63
COPAY
Brand/PA** Brand/PA**
MEDICATION
Novolin N Novolin N Novolin N Levemir Levemir Lantus Lantus Lantus
STRENGTH
Vial Penfill Innolet Vial Flexpen Vial Opticlick Solostar
QUANTITY
10ml 15ml 15ml 10ml 15ml 10ml 15ml 15ml
COST
$ 46.70 $147.89 $ 99.40 $107.48 $207.58 $107.46 $207.56 $207.56
COPAY
Brand Brand Brand Brand Brand Brand Brand Brand
MEDICATION
Novolin 70/30 Novolin 70/30 Novolin 70/30 Novolin R Novolin R Novolin R Novolog Novolog Novolog
STRENGTH
Vial Penfill Innolet Vial Penfill Innolet Vial Penfill Flexpen
QUANTITY
10ml 15ml 15ml 10ml 15ml 15ml 10ml 15ml 15ml
COST
$ 46.70 $147.89 $ 99.40 $ 46.70 $147.89 $ 99.40 $115.84 $215.18 $223.75
COPAY
Brand Brand Brand Brand Brand Brand Brand Brand Brand
AVERAGE % DECREASE IN A1C 1.5%-2.5% 1.5%-2.5% 1.5%-2.5%
1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% 1.5%-2.5% $4.00/30-day supply and
Novolog Mix Vial 10ml $115.84 Brand 70/30 Novolog Mix Penfill 15ml $215.18 Brand 70/30 Novolog Mix Flexpen 15ml $223.75 Brand 70/30 * Medication can be found on the participating $4.00 pharmacy lists. (Quantity limits apply.) $10.00/90-day supply. **PA= Prior Authorization required.
[PPC070901ML]