Diabetes Medications List

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]

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