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BCBS NC - Universal Diabetes Formulary
BCBS NC - Universal Diabetes Formulary
Max Anderegg avatar
Written by Max Anderegg
Updated over a week ago

Within this document, you'll find the BCBS NC Universal Diabetes Formulary as of January 1, 2024. For the most up-to-date medication and supply coverage information, please visit the BCBS NC Member Resource Center.

💡BCBS NC Knowlege Center - Drug Search

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 (CONCENTRATE) – insulin regular (human) inj 500 unit/ml

HUMULIN R U-500 KWIKPEN – insulin regular (human) soln pen-injector 500 unit/ml

LEVEMIR – insulin detemir inj 100 unit/ml

LEVEMIR FLEXPEN - insulin detemir soln pen-injector 100 unit/ml

NOVOLIN N – insulin nph (human) (isophane) inj 100 unit/ml

NOVOLIN N RELION – 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 R – insulin regular (human) inj 100 unit/ml

NOVOLIN R RELION – insulin regular (human) inj 100 unit/ml

NOVOLIN R FLEXPEN – insulin regular (human) soln pen-injector 100 unit/ml

NOVOLIN R FLEXPEN RELION – insulin regular (human) soln pen-injector 100 unit/ml

NOVOLIN 70/30 – insulin nph isophane & regular human inj 100 unit/ml (70-30)

NOVOLIN 70/30 RELION – 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)

NOVOLOG – insulin aspart inj soln 100 unit/ml

NOVOLOG FLEXPEN – insulin aspart soln pen-injector 100 unit/ml

NOVOLOG FLEXPEN RELION – 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 PREFILLED FLEXPEN – insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)

NOVOLOG MIX 70/30 PREFILLED FLEXPEN RELION – insulin aspart prot & aspart sus pen-inj 100 unit/ml (70-30)

NOVOLOG MIX 70/30 RELION – insulin aspart prot & aspart (human) inj 100 unit/ml (70-30)

NOVOLOG PENFILL – insulin aspart soln cartridge 100 unit/ml

NOVOLOG RELION – insulin aspart inj 100 unit/ml

SEMGLEE – insulin glargine-yfgn inj 100 unit/ml

SEMGLEE – insulin glargine-yfgn soln pen-injector 100 unit/ml

TOUJEO SOLOSTAR – insulin glargine soln pen-injector 300 unit/ml (1 unit dial)

TOUJEO MAX SOLOSTAR – insulin glargine soln pen-injector 300 unit/ml (2 unit dial)

TRESIBA – insulin degludec inj 100 unit/ml

TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 100 unit/ml

TRESIBA FLEXTOUCH – insulin degludec soln pen-injector 200 unit/ml

Generic Oral

acarbose tab 25 mg (Precose)

acarbose tab 50 mg (Precose)

acarbose tab 100 mg (Precose)

glimepiride tab 1 mg

glimepiride tab 2 mg

glimepiride tab 4 mg

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 tab 5 mg

glipizide tab 10 mg

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

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

nateglinide tab 60 mg

nateglinide tab 120 mg

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-metformin hcl tab 15-500 mg

pioglitazone hcl-metformin hcl tab 15-850 mg (Actoplus met)

repaglinide tab 0.5 mg

repaglinide tab 1 mg

repaglinide tab 2 mg

Diabetic Supplies

Calibration Liquid

  • ASCENCIA CONTOUR

  • ASCENCIA CONTOUR NEXT

  • LIFESCAN ONETOUCH ULTRA

  • LIFESCAN ONETOUCH VERIO

Insulin Syringes

Lancets

Lancet Devices

Pen Needles

Test Strips & Discs

  • ASCENCIA CONTOUR

  • ASCENCIA CONTOUR NEXT

  • LIFESCAN ONETOUCH ULTRA

  • LIFESCAN

  • ONETOUCH ULTRA BLUE

  • LIFESCAN

  • ONETOUCH VERIO

Oral - Brand DPP4

GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg

GLYXAMBI – empagliflozin-linagliptin tab 25-5 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)

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 5-2.5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 10-5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 12.5-2.5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 25-5-1000 mg

Oral - Brand SGLT2

FARXIGA – dapagliflozin propanediol tab 5 mg (base equivalent)

FARXIGA – dapagliflozin propanediol tab 10 mg (base equivalent)

GLYXAMBI – empagliflozin-linagliptin tab 10-5 mg

GLYXAMBI – empagliflozin-linagliptin tab 25-5 mg

JARDIANCE – empagliflozin tab 10 mg

JARDIANCE – empagliflozin tab 25 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

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 5-2.5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 10-5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 12.5-2.5-1000 mg

TRIJARDY XR – empagliflozin-linagliptin-metformin tab er 24hr 25-5-1000 mg

XIGDUO XR - dapagliflozin prop-metformin hcl tab er 24hr 2.5-1000 mg

XIGDUO XR - dapagliflozin prop-metformin hcl tab er 24hr 5-500 mg

XIGDUO XR - dapagliflozin prop-metformin hcl tab er 24hr 5-1000 mg

XIGDUO XR - dapagliflozin prop-metformin hcl tab er 24hr 10-500 mg

XIGDUO XR - dapagliflozin prop-metformin hcl tab er 24hr 10-1000 mg

GLP-1 - Oral & Other Injectables

MOUNJARO - tirzepatide soln pen-injector 2.5 mg/0.5 ml

MOUNJARO - tirzepatide soln pen-injector 5 mg/0.5 ml

MOUNJARO - tirzepatide soln pen-injector 7.5 mg/0.5 ml

MOUNJARO - tirzepatide soln pen-injector 10 mg/0.5 ml

MOUNJARO - tirzepatide soln pen-injector 12.5 mg/0.5 ml

MOUNJARO - tirzepatide soln pen-injector 15 mg/0.5 ml

OZEMPIC - semaglutide soln pen-inj 0.25 or 0.5 mg/dose (2 mg/3 ml)

OZEMPIC – semaglutide soln pen-inj 1 mg/dose (4 mg/3 ml)

OZEMPIC – semaglutide soln pen-inj 2 mg/dose (8 mg/3 ml)

RYBELSUS – semaglutide tab 3 mg

RYBELSUS – semaglutide tab 7 mg

RYBELSUS – semaglutide tab 14 mg

TRULICITY – dulaglutide soln pen-injector 0.75 mg/0.5 ml

TRULICITY – dulaglutide soln pen-injector 1.5 mg/0.5 ml

TRULICITY – dulaglutide soln pen-injector 3 mg/0.5 ml

TRULICITY – dulaglutide soln pen-injector 4.5 mg/0.5 ml

GLP-1 / Insulin Combinations - Brand

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

Continuous Blood Glucose Monitors (CGMs)

DEXCOM G5 Mobile Receiver, G5/G6 Receiver Kits

DEXCOM G5 Mobile Sensor, G6 Sensor Kits

DEXCOM Mobile G5 Transmitter, G6 Transmitter

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