L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyAntihyperglycemic, Dpp-4 InhibitorsT3 alogliptin benzoate NESINA STT2 linagliptinTRADJENTAT3 saxagliptin hcl ONGLYZA STT2 sitagliptin phosphate JANUVIAAntihyperglycemic, Insulin-release StimulantTypeT1 chlorpropamide CHLORPROPAMIDET1 glimepiride AMARYLT1 glipizideGLUCOTROLT2 glyburideDIABETAT1 glyburideGLYBURIDET1 glyburide,micronized GLYNASET1 nateglinideSTARLIXT2 repaglinide PRANDINT1 tolazamideTOLAZAMIDET1 tolbutamide TOLBUTAMIDEAntihyperglycemic, Insulin-responseEnhancerT1 pioglitazone hcl ACTOST3 rosiglitazone maleate AVANDIA STAntihyperglycemic,biguanide TypeT1 metformin hcl GLUCOPHAGET3 metformin hcl GLUMETZA STT2 metformin hcl RIOMETAntihyperglycemic,insulin-rel Stim.&Biguanide CmbT1 glipizide/metformin METAGLIPhclT1 glyburide/metformin GLUCOVANCEhclT2 repaglinide/metformin PRANDIMEThclAntihyperglycemic,insulin-response &Release Comb.T1 pioglitazone DUETACThcl/glimepirideT3 rosiglitazone/glimepirid AVANDARYLeSTSTAntihyperglycemic-glucocorticoid ReceptorBlockerT4 mifepristone KORLYM PAAntihyperglycm,insul-resp.enhancer &Biguanide CmbT1 pioglitazonehcl/metformin hclT2 pioglitazonehcl/metformin hclACTOPLUS METACTOPLUS MET XRSTSTT3 rosiglitazone/metformin hclBlood Sugar DiagnosticsAVANDAMETT3 blood sugar diagnostic ALL ABBOTTPRODUCTS(FREESTYLE ANDPRECISION TESTSTRIPS)T3 blood sugar diagnostic ALL BAYERPRODUCTS(CONTOUR ANDBREEZE TESTSTRIPS)Diabetic SuppliesT2 blood glucose cntl hi & 2TEK(OTC)normalT2 blood glucose cntl hi & AGAMATRIXnormalCONTROL(OTC)T2 blood glucose cntl hi & ASSURE DOSE(OTC)normalT2 blood glucose cntl hi & BLOOD GLUCOSEnormalCONTROL(OTC)T2 blood glucose cntl hi & ON CALL PLUSnormalCONTROL(OTC)T2 blood glucose cntl hi & ON CALL VIVIDnormalCONTROL(OTC)T2 blood glucose cntl hi & OPTUMRX(OTC)normalT2 blood glucose control ACCU-CHEK(OTC)high&lowT2 blood glucose control ACCUTRENDhigh&lowGLUCOSE(OTC)T2 blood glucose control ASCENSIAhigh&lowAUTODISC(OTC)T2 blood glucose control ASCENSIAhigh&lowELITE(OTC)T2 blood glucose control ASSURE 3(OTC)high&lowT2 blood glucose control ASSURE PRO(OTC)high&lowT2 blood glucose control EASY TOUCH(OTC)high&lowT2 blood glucose control EVENCARE G2(OTC)high&lowT2 blood glucose control EVENCARE G3(OTC)high&lowT2 blood glucose control EVENCARE(OTC)high&lowT2 blood glucose control FREESTYLEhigh&lowCONTROLSOLUTION(OTC)T2 blood glucose control MICRODOT(OTC)high&lowT2 blood glucose controlhigh&lowT2 blood glucose controlhigh&lowT2 blood glucose controlhigh&lowSURESTEPCONTROLSOLUTION(OTC)TELCARE CONTROLSOLUTION(OTC)ULTRATRAKPRO(OTC)STPage 24 of 91