Preferred Drug List 2013 Standard Formulary (3 ... - Express Scripts

TIER
DRUG NAME
1 2 3
SOF‐SET X
SOF‐SET MICRO X
SURE‐T X
SUGGESTED PREFFERED ALTERNATIVES
18.1 DIABETIC SUPPLIES
ACCU‐CHEK X
ACCU‐CHEK ACTIVE X
ACCU‐CHEK AVIVA X
ACCU‐CHEK AVIVA PLUS X
ACCU‐CHEK COMFORT CURVE X
ACCU‐CHEK COMPACT X
ACCU‐CHEK COMPACT BLUE CONTROL X
ACCU‐CHEK FASTCLIX X
ACCU‐CHEK NANO SMARTVIEW X
ACCU‐CHEK SMARTVIEW X
ACCU‐CHEK SOFTCLIX X
ASCENSIA AUTODISC X ACCU‐CHEK, ONE TOUCH
AUTODISC NORMAL X ACCU‐CHEK, ONE TOUCH
BREEZE 2 X ACCU‐CHEK, ONE TOUCH
CONTOUR X ACCU‐CHEK, ONE TOUCH
CONTOUR NEXT X ACCU‐CHEK, ONE TOUCH
CONTOUR NEXT EZ X ACCU‐CHEK, ONE TOUCH
CONTOUR USB X ACCU‐CHEK, ONE TOUCH
CONTROL SOLUTION X ACCU‐CHEK, ONE TOUCH
FORA LANCETS X
FORA LANCING DEVICE X
FORA TEST STRIP X ACCU‐CHEK, ONE TOUCH
FORA V30A X ACCU‐CHEK, ONE TOUCH
FREESTYLE FREEDOM LITE X ACCU‐CHEK, ONE TOUCH
FREESTYLE INSULINX X ACCU‐CHEK, ONE TOUCH
FREESTYLE INSULINX TEST STRIPS X ACCU‐CHEK, ONE TOUCH
FREESTYLE LITE METER X ACCU‐CHEK, ONE TOUCH
FREESTYLE LITE STRIPS X ACCU‐CHEK, ONE TOUCH
FREESTYLE TEST STRIPS X ACCU‐CHEK, ONE TOUCH
GLUCOSE TEST STRIP X ACCU‐CHEK, ONE TOUCH
GUARDIAN RT STARTER KIT X
NOVOFINE X
NOVOFINE 32 X
NOVOFINE AUTOCOVER X
ONE TOUCH LANCETS X
ONE TOUCH TEST STRIPS X
ONE TOUCH ULTRA 2 X
ONE TOUCH ULTRA SMART X
ONE TOUCH ULTRA SYSTEM X
ONE TOUCH ULTRA TEST STRIPS X