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Quick Guide to Diabetes Medications

2013 Aetna Preferred Drug List information for Commercial plans*. Quick Guide to Diabetes Medications LOWEST TIER MIDDLE TIER HIGHEST TIER. preferred generics preferred brands nonpreferred brands and generics Oral Medications acarbose ACTOPLUS MET ALL BRANDED EQUIVALENTS GLUCOPHAGE XR (metformin). chlorpropamide (pioglitazone HCl & metformin HCl) LISTED UNDER LOWEST-TIER GLUCOTROL (glipizide). glimepiride CYCLOSET (bromocriptine) GLUCOTROL XL. glipizide JANUMET (sitagliptin/metformin HCI) ACTOPLUS MET XR (glipizide extended release). glipizide ER/XL JANUMET XR (sitagliptin/metformin (pioglitazone HCI and metformin HCI GLUCOVANCE (glyburide and glipizide/metformin HCI extended-release) extended release) FE, ST metformin) FE. glyburide JANUVIA (sitagliptin) ACTOS (pioglitazone) ST GLUMETZA (metformin hydrochloride). glyburide/metformin JENTADUETO (linagliptin and AMARYL (glimepiride) FE GLYNASE (glyburide).)

05.03.887.1 C (03/13) *Calculations based on 12 prescriptions per year. All member care and related decisions are the sole responsibility of the physician, and this information does not dictate or control

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Transcription of Quick Guide to Diabetes Medications

1 2013 Aetna Preferred Drug List information for Commercial plans*. Quick Guide to Diabetes Medications LOWEST TIER MIDDLE TIER HIGHEST TIER. preferred generics preferred brands nonpreferred brands and generics Oral Medications acarbose ACTOPLUS MET ALL BRANDED EQUIVALENTS GLUCOPHAGE XR (metformin). chlorpropamide (pioglitazone HCl & metformin HCl) LISTED UNDER LOWEST-TIER GLUCOTROL (glipizide). glimepiride CYCLOSET (bromocriptine) GLUCOTROL XL. glipizide JANUMET (sitagliptin/metformin HCI) ACTOPLUS MET XR (glipizide extended release). glipizide ER/XL JANUMET XR (sitagliptin/metformin (pioglitazone HCI and metformin HCI GLUCOVANCE (glyburide and glipizide/metformin HCI extended-release) extended release) FE, ST metformin) FE. glyburide JANUVIA (sitagliptin) ACTOS (pioglitazone) ST GLUMETZA (metformin hydrochloride). glyburide/metformin JENTADUETO (linagliptin and AMARYL (glimepiride) FE GLYNASE (glyburide).)

2 Glyburide micronized metformin) AVANDAMET (rosiglitazone/ GLYSET (miglitol) FE, #. glycron JUVISYNC (simvastatin and sitagliptin) metformin) FE, PR METAGLIP (glipizide/metformin) FE. metformin KOMBIGLYZE XR (saxagliptin and AVANDARYL (rosiglitazone maleate PRANDIMET. metform ER metformin HCI extended release) and glimepiride) FE, PR (repaglinide and metformin) FE. nateglinide ONGLYZA (saxagliptin) AVANDIA (rosiglitazone) FE, PR PRECOSE (acarbose) FE. tolazamide PRANDIN (repaglinide) # DUETACT (pioglitazone HCl and RIOMET (metformin hydrochloride). tolbutamide TRADJENTA (linagliptin) glimepiride) FE, ST STARLIX (nateglinide) #, FE. FORTAMET (metformin osmotic SR) FE. GLUCOPHAGE (metformin). Injectable Medications No generics BYDUREON (exenatide extended- release APIDRA (insulin detemir NOVOLIN R VIAL/PENFILL (regular available in for injectable suspension) QL [rDNA orgin] injection) FE insulin-human) FE, ST.

3 This category HUMALOG VIAL/PEN (insulin lispro) BYETTA (exenatide injection) QL RELION 70/30 R (insulin regular HUMALOG MIX 75/25 VIAL/PEN NOVOLIN 70/30 VIAL/PENFILL & isophane-human) FE, ST. (insulin lispro/lispro protamine) (insulin regular & isophane- RELION N (NPH insulin HUMULIN 50/50 (insulin regular & human) FE, ST isophane-human) FE, ST. isophane - human) NOVOLIN N VIAL/PENFILL RELION R (regular insulin-human) FE, ST. HUMULIN 70/30 VIAL/PEN (NPH insulin isophane-human) FE, ST. (insulin regular & isophane - human). HUMULIN N VIAL/PEN. (NPH insulin isophane - human). HUMULIN R (regular insulin - human). LANTUS (insulin glargine [rDNA origin] injection). LEVEMIR VIAL/FLEXPEN. (insulin detemir (rDNA origin) injection). NOVOLOG VIAL /FLEXPEN. (insulin aspart [rDNA origin] injection). NOVOLOG MIX 70/30 (70% insulin aspart protamine suspension & 30%.)

4 Insulin aspart injection [rDNA origin]). SYMLIN/PEN (pramlintide acetate) PR. VICTOZA (liraglutide [rDNA orgin] injection) QL. Supplies & Others cvs glucose gel 40% FREESTYLE INSULINX STRIPS ACCU-CHEK Aviva, ANY other brand name pen needles dex4 glucose gel 40% FREESTYLE TEST STRIPS BREEZE 2, CONTOUR ST is subject to the highest-tier, EXCEPT. gluco burst gel 40% FREESTYLE LITE TEST STRIPS ANY other brand name test strips is the pen needles documented at left, glucose chw 4mg ONETOUCH FASTTAKE TEST STRIPS subject to the highest-tier, EXCEPT , see middle-tier information . ST. glucose gel 40% ONETOUCH ULTRA TEST STRIPS the Test Strips documented at left, glutose 15 gel 40% PRECISION XTRA KETONE STRIPS , see middle-tier information . ST. glutose 45 gel 40% PRECISION XTRA TEST STRIPS Calibration solutions that are routinely insta-glucos gel 40% ANY other brand name insulin syringe used for Lifescan and Abbott blood monojel gel 40% PROGLYCEM (diazoxide) is subject to the highest-tier, EXCEPT glucose meters are covered insulin syringes documented at left, BD LANCETS , see middle-tier information .

5 BD PEN NEEDLES (needles). BD SYRINGES. UPPERCASE Brand-name medication # Brand-name medication expected to become lowercase italics Generic medication available generically in the near future. After the generic medication becomes available, the brand-name FE Formulary excluded in closed formulary plans medication may be covered at a higher copayment and/or PR Precertification required under most plans added to the Formulary Exclusions List. The brand-name QL Quantity Limit applies under most plans medication may also be subject to precertification and/or ST Step-therapy applies under most plans step-therapy. *Commercial plans = Non-Medicare plans 2013 Aetna Inc. C (4/13). Quality health plans & benefits Healthier living Financial well-being Intelligent solutions 2013 Aetna Preferred Drug List information Pharmacy Benefits Reference Help your patients save money Option 1: Your patient's benefits plan may have a higher copayment If your patient is currently taking a nonpreferred drug and for drugs that aren't on the Preferred Drug List.

6 You can help the copayment is $35 per month, your patient's total cost is patients save money by prescribing drugs on the Preferred $420 per year.*. Drug List, if appropriate. Here's an example: If your patient is switched to a Preferred Generic Drug and The choices you and your patients make about prescription the copayment is $10 per month, your patient's total cost is Medications affect health care costs. Drug prices are a main $120 per year.*. reason that insurance prices have gone up. Your patient can save $300 per year on just one prescription medication by switching to a preferred generic drug. To submit medical exception or precertification requests for Aetna prescription Medications : Option 2: Fax the Precertification Unit at 1-877-269-9916. If your patient is currently taking a nonpreferred drug and Call the Precertification Unit at 1-855-240-0535.

7 The copayment is $35 per month, your patient's total cost is To submit requests online through our secure $420 per year.*. provider website: If your patient is switched to a Brand-Name Preferred Drug Go to and the copayment is $20 per month, your patient's total Click Health Care Professionals then Medical cost is $240 per year.*. Professionals Log In. Your patient can save $180 per year on just one prescription Once logged in, select Plan Central then Aetna medication by switching to a preferred brand-name drug. Health Plan and Precertifications.. You can find current drug information online at *Calculations based on 12 prescriptions per year. All member care and related decisions are the sole responsibility of the physician, and this information does not dictate or control physicians' clinical decisions regarding the appropriate care of members.

8 Pharmacy benefits are not limited to the drugs on the Preferred Drug List. Drugs on the Formulary Exclusions List may be excluded from coverage under some pharmacy benefits plans unless a medical exception is obtained. Many drugs on the Preferred Drug List are subject to manufacturer rebate arrangements between Aetna and the manufacturer of those drugs. The drugs on the Preferred Drug List, Formulary Exclusions, Precertification, Quantity Limit and Step-Therapy Lists are subject to change. The precertification, quantity limits and step therapy drug coverage review programs are not available in all service areas. For example, precertification and step therapy programs do not apply to fully insured members in Indiana. Step-therapy does not apply to fully insured members in New Jersey. However, these programs are available to self-insured plans.

9 Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies. The Aetna companies that offer, underwrite or administer benefits coverage include: Aetna Health Inc., Aetna Health of California Inc., Aetna Health Insurance Company of New York, Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT 06156. Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC. This card may not be used after 12/31/13. C (03/13).


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