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August 2021

Healthy Blue Hot Tip: Diabetes

Your Healthy Blue patients on nonpreferred products may experience a pharmacy claim rejection. To avoid additional steps or delays at the pharmacy, consider prescribing preferred products whenever possible. Prior authorization (PA) and step therapy (ST) may apply to select preferred products. Coverage should be verified by reviewing the Preferred Drug List (PDL) on the Healthy Blue website. The PDL is subject to change quarterly.

Therapeutic Nonpreferred products Preferred products class Short-acting Short-acting Afrezza ( regular) Admelog () Apidra (isulin glulisine) Insulin Lispro (Humalog authorized Fiasp () generic) Humalog (insulin lispro) Insulin Aspart (Novolog authorized Novolog (insulin aspart) generic)

Long-acting Intermediate-acting Lantus () Humulin R & Novolin R (insulin Levemir () regular) Toujeo (insulin glargine) Humulin N & Novolin N (insulin NPH) Tresiba ()

1 Long-acting Insulin Basaglar (insulin glargine) Semglee (insulin glargine)

Mixes Insulin Lispro Mix (Humalog Mix) Humalog Mix (insulin lispro) Humulin Mix (insulin NPH & insulin regular) Insulin Aspart Mix (Novolog Mix authorized generic) Novolin Mix (insulin NPH & insulin regular) Novolog Mix (insulin aspart) GLP-1s2 Adlyxin () Ozempic () Bydureon () Trulicity () Byetta (exenatide) Victoza () Tanzeum ()

www.HealthyBlueSC.com BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. BlueChoice HealthPlan has contracted with Amerigroup Partnership Plan, LLC, an independent company, for services to support administration of Healthy Connections. To report fraud, call our confidential Fraud Hotline at 877-725-2702. You may also call the South Carolina Department of Health and Human Services Fraud Hotline at 888-364-3224 or email [email protected]. BSCPEC-2064-21 August 2021 Healthy Blue Healthy Blue Hot Tip: Diabetes Page 2 of 2

Therapeutic Nonpreferred products Preferred products class GLP-1/long- Soliqua (lixisenatide/insulin glargine) acting insulin Xultophy (liraglutide/insulin degludec) combo3 DPP4-s2 (generic Nesina) Januvia () Nesina (alogliptin) Onglyza () Tradjenta ()

Alogliptin/metformin2 (generic Kazano) Janumet & Janumet XR (sitagliptin/ DPP4 2 Combo Alogliptin/ (generic Oseni) ) products3 Jentadueto & Jentadueto XR (linagliptin/metformin) Kazano (alogliptin/metformin) Kombiglyze XR (saxagliptin/ metformin) Oseni2 (alogliptin/pioglitazone) SGLT22 Farxiga () Jardiance () Invokana () Streglatro ()

Glyxambi (empagliflozin/ linagliptin) Synjardy & Synjardy XR SGLT2 Invokamet & Invokamet XR (empaglflozin/ metformin) Combo 3 (canagliflozin/metformin) products Qtern (dapagliflozin/ saxagliptin) Segluromet (ertugliflozin/ metformin) Steglujan (ertugliflozin/ sitagliptin)Xigduo XR (dapagliflozin/ metformin) TZDs4 Actos (pioglitazone) Pioglitazone (generic Actos) Actoplus Met & Actoplus Met XR (pioglitazone/metformin) Pioglitazone-Metformin (generic Avandia () Actoplus Met) Avandamet (rosiglitazone/ metformin) Duetact (pioglitazone/) Pioglitazone-Glimepiride (generic Duetact) Diabetic All other manufacturers for pen needles BD pen needles and insulin syringes supplies and insulin syringes are nonpreferred are the preferred product for diabetic products and may require prior supplies. authorization. 1 Insulin quantities are limited to 30 ml per 30 days. 2 All anti-diabetic agents require step therapy through metformin unless contraindicated. 3 Combination agents require trial of individual agents and rational regarding clinical necessity of combination product. 4 TZDs have step therapy through metformin and one preferred drug within any of the following classes: DPP4s, GLP-1s, SGLT2s

If you have questions regarding this Hot Tip, call the Customer Care Center at 866-757-8286. To view the PDL, visit www.HealthyBlueSC.com and select Providers.