This may be based on how well they work, if they have less side effects, if they’re more affordable, etc. 0000010678 00000 n 0000001176 00000 n 0000013130 00000 n Did you know that Walmart sells Novolin Regular human insulin and Novolin N insulin (commonly known as NPH) for approximately $20 a vial?
0000004145 00000 n These drugs may have a lower cost alternative on Tier One or Tier Two. Insulin pump therapy.

Follow state or local laws about how to dispose of this container. 3augmentin amoxicillin/potassium clav 3augmentin es-600 amoxicillin/potassium clav 3augmentin xr amoxicillin/potassium clav 2autoshield duo pen needle pen needle, diabetic, safety 2autoshield pen needle needles, insulin disp., safety 3avalide irbesartan/hydrochlorothiazide 3avapro irbesartan 2avc sulfanilamide 3avelox moxifloxacin hcl 0000004627 00000 n trailer < 0000003542 00000 n Medications may move to a lower tier at any time. 0000024729 00000 n Ask your doctor about any risk.Trulicity is not approved for use by anyone younger than 18 years old.Use Trulicity exactly as prescribed by your doctor. 0000005569 00000 n Do not use two doses at one time.Do not use Trulicity twice within a 72-hour period.Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.Stop using Trulicity and get emergency medical help if you have Tell your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. It is not known whether these effects would occur in people using regular doses. Generic drugs on the published list. Drug Tier Includes. Four-tier drug benefit Generic drugs not included in Tier 1. 5 0 obj Tier 4: Nonpreferred drug. Ask your doctor about your risk.You should not use Trulicity if you are allergic to dulaglutide, or if you have:multiple endocrine neoplasia type 2 (tumors in your glands);a personal or family history of medullary thyroid carcinoma (a type of thyroid cancer); ordiabetic ketoacidosis (call your doctor for treatment).In animal studies, Trulicity caused thyroid tumors or thyroid cancer. 0000036173 00000 n When a medication changes tiers, you may have to pay a different amount for that medication. Preferred brand (tier two)—Preferred brand name drugs.

A member pays the copayment directly to the provider when he/she receives a covered … Your plan may have multiple or no tiers. 0000012778 00000 n If your prescription drug is not on this list, it is not covered under our four-tier benefit structure. 0000014181 00000 n 0000015069 00000 n Please note: If you have a high-deductible plan, the tier cost levels will apply once you meet your deductible. Tier 4 – Your Highest-Cost Option Tier.4.medications.are.your.highest-cost.option ..If.you.are. AÌs�K���j����-m��D�A�ʒI�_,F��;��}�~�e�N�����[A�Gˑ�6���n�f�ܼ)#���������`�ڜ"f j�/je��c��n��K�e�p�b�\� ��) � �88����y��Ǧ����O�!���*��Z5���_CL�\9��T�p �͵N�hE��c�U��6��y�����xȗ�������G*K�n����T`�tF��͔F��_��gL}RE��|��~�%�m��ʲP��{�ۏ Ӥ���O�fN��6�+�M0xoHn�ڮIN�jΉ���;��@*쇅��L�U�ͫ�AeA��n�!|�6�;�!��;�N��t�w���^~��G#����ɧ�#���#��E���j5�II'��|g����Ut�{6f���^�{#���[h��Š��f+t��ʲt�-����U RI�1�� %�쏢 0000043040 00000 n 0000006828 00000 n Tier information .

0000008331 00000 n Follow all directions on your prescription label and read all medication guides or instruction sheets.Trulicity is injected under the skin once per week.


0000043212 00000 n

To help maintain affordability in the pharmacy benefit, we encourage the use of cost-effective drugs and preferred brand names through the three-tier program. prescription for a Tier 1, Tier 2, or Tier 3 drug (as defined below); however, there may be instances when only a Tier 3 drug is appropriate, which will require a higher copayment. 0000011241 00000 n ����&��"Ʒf*Q�s�J'�4E�]6��b��&�@p�s�"@T�,���;x�͏ b�%n� J" 0000007652 00000 n APIDRA SOLOSTAR Insulin Pen 3 NF Humalog Kwikpen APLENZIN Tablet Sustained Release 24 hr 3 4 bupropion HCl; Budeprion SR; Budeprion XL APOMORPHINE Powder 3 4 CONSULT YOUR PHYSICIAN APTIVUS Capsule 3 4 CONSULT YOUR PHYSICIAN APTIVUS Solution 3 4 CONSULT YOUR PHYSICIAN GNHHYKYEN Page 4 of 61. 0000006792 00000 n Call your doctor for medical advice about side effects. -If used in combination with insulin or an insulin secretagogue, a lower dose of insulin or the insulin secretagogue should be considered to reduce the risk of hypoglycemia.-This drug is not recommended as a first-line therapy. 0000006635 00000 n 0000035627 00000 n Keep it out of the reach of children and pets.Store Trulicity Pens in the refrigerator, protected from light.