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 STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Glyburide 1.25mg 100 $12.44 Generic 1.5%
Glyburide 2.5mg 100 $18.93* Generic 1.5%
Glyburide 5mg 100 $28.31* Generic 1.5%
Glyburide MCR 1.5mg 100 $18.75 Generic 1.5%
Glyburide MCR 3mg 100 $21.75* Generic 1.5%
Glyburide MCR 6mg 100 $35.00* Generic 1.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Glipizide 5mg 100 $ 6.99* Generic 1.5%
Glipizide 10mg 100 $11.92* Generic 1.5%
Glipizide ER 2.5mg 100 $32.53 Generic 1.5%
Glipizide ER 5mg 100 $32.53 Generic 1.5%
Glipizide ER 10mg 100 $32.53 Generic 1.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Glimepiride 1mg 100 $13.41* Generic 1.5%
Glimepiride 2mg 100 $21.74* Generic 1.5%
Glimepiride 4mg 100 $41.00* Generic 1.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Metformin 500mg 100 $35.57* Generic 1.5%
Metformin 850mg 100 $38.63* Generic 1.5%
Metformin 1000mg 100 $45.97* Generic 1.5%
Metformin XR 500mg 100 $30.55* Generic 1.5%
Metformin XR 750mg 100 $94.99 Generic 1.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Precose 25mg 100 $101.06 Brand 0.7%-1%
Precose 50mg 100 $114.31 Brand 0.7%-1%
Precose 100mg 100 $130.31 Brand 0.7%-1%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Avandia 2mg 100 $275.93 Brand 0.7%-1%
Avandia 4mg 100 $409.53 Brand 0.7%-1%
Avandia 8mg 100 $744.13 Brand 0.7%-1%
Actos 15mg 100 $501.27 Brand 0.7%-1%
Actos 30mg 100 $766.00 Brand 0.7%-1%
Actos 45mg 100 $830.93 Brand 0.7%-1%
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MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Starlix 60mg 100 $184.70 Brand 0.1%-0.7%
Starlix 120mg 100 $191.90 Brand 0.1%-0.7%
Prandin 1mg 100 $202.23 Brand 1.5%
Prandin 2mg 100 $202.23 Brand 1.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Januvia 25mg 100 $668.47 Brand/PA** 0.6%-0.8%
Januvia 50mg 100 $668.43 Brand/PA** 0.6%-0.8%
Januvia 100mg 100 $668.47 Brand/PA** 0.6%-0.8%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Byetta 5mcg 1.2ml $214.22 Brand/PA** 0.5%-1%
Byetta 10mcg 2.4ml $282.63 Brand/PA** 0.5%-1%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Novolin N Vial 10ml $ 46.70 Brand 1.5%-2.5%
Novolin N Penfill 15ml $147.89 Brand 1.5%-2.5%
Novolin N Innolet 15ml $ 99.40 Brand 1.5%-2.5%
Levemir Vial 10ml $107.48 Brand 1.5%-2.5%
Levemir Flexpen 15ml $207.58 Brand 1.5%-2.5%
Lantus Vial 10ml $107.46 Brand 1.5%-2.5%
Lantus Opticlick 15ml $207.56 Brand 1.5%-2.5%
Lantus Solostar 15ml $207.56 Brand 1.5%-2.5%
MEDICATION STRENGTH QUANTITY COST COPAY AVERAGE %
DECREASE IN A1C
Novolin 70/30 Vial 10ml $ 46.70 Brand 1.5%-2.5%
Novolin 70/30 Penfill 15ml $147.89 Brand 1.5%-2.5%
Novolin 70/30 Innolet 15ml $ 99.40 Brand 1.5%-2.5%
Novolin R Vial 10ml $ 46.70 Brand 1.5%-2.5%
Novolin R Penfill 15ml $147.89 Brand 1.5%-2.5%
Novolin R Innolet 15ml $ 99.40 Brand 1.5%-2.5%
Novolog Vial 10ml $115.84 Brand 1.5%-2.5%
Novolog Penfill 15ml $215.18 Brand 1.5%-2.5%
Novolog Flexpen 15ml $223.75 Brand 1.5%-2.5%
Novolog Mix Vial 10ml $115.84 Brand 1.5%-2.5%
70/30
Novolog Mix Penfill 15ml $215.18 Brand 1.5%-2.5%
70/30
Novolog Mix Flexpen 15ml $223.75 Brand 1.5%-2.5%
70/30
* Medication can be found on the participating $4.00 pharmacy lists. (Quantity limits apply.) $4.00/30-day supply and
$10.00/90-day supply.
**PA= Prior Authorization required.
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