Diabetes, Miscellaneous Antidiabetic Agents
PDL Reference Documents
Newsletters
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Carveout ‐ Bill FFS |
Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|---|
| 00054014225 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 23155014901 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 62135045590 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 64380076006 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 69543012210 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 69543012211 | ACARBOSE | acarbose | TABLET | 100 mg | N | Y | N | |
| 00054014025 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 23155014701 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 23155014705 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 62135045390 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 64380075806 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 69543012010 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 69543012011 | ACARBOSE | acarbose | TABLET | 25 mg | N | Y | N | |
| 00054014125 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 23155014801 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 62135045490 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 64380075906 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 69543012110 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 69543012111 | ACARBOSE | acarbose | TABLET | 50 mg | N | Y | N | |
| 00093745501 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-250 mg | N | Y | N | |
| 23155011501 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-250 mg | N | Y | N | |
| 62135073160 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-250 mg | N | Y | N | |
| 68382018401 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-250 mg | N | Y | N | |
| 00093745601 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 23155011601 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 62135073260 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 68382018501 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 00093745701 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 23155011701 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 62135073360 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 68382018601 | GLIPIZIDE-METFORMIN | glipizide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 23155023301 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 1.25 mg-250 mg | N | Y | N | |
| 55111069501 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 1.25 mg-250 mg | N | Y | N | |
| 57237002301 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 1.25 mg-250 mg | N | Y | N | |
| 65862008001 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 1.25 mg-250 mg | N | Y | N | |
| 65862008005 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 1.25 mg-250 mg | N | Y | N | |
| 00093726105 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 23155023401 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 50268035611 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 50268035615 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 57237002401 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 57237002405 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 65862008101 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 65862008105 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 2.5 mg-500 mg | N | Y | N | |
| 00093726205 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 23155023501 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 57237002501 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 57237002505 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 65862008201 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 65862008205 | GLYBURIDE-METFORMIN HCL | glyburide/metformin HCl | TABLET | 5 mg-500 mg | N | Y | N | |
| 31722004247 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 42571036007 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 42571036010 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 52817082005 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 52817082050 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 66689031816 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 69452038088 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 71656001704 | METFORMIN HCL | metformin HCl | SOLUTION | 500 mg/5 mL | N | Y | N | |
| 00378600191 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 00591272060 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 27241018960 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 42806040660 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 50228050460 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 50742063460 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 59651004360 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 68180033707 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 1,000 mg | N | Y | N | |
| 00378600291 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 00591271960 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 27241018860 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 42806040560 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 50228050360 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 50742063360 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 59651004260 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 68180033607 | METFORMIN ER OSMOTIC | metformin HCl | TAB ER 24 | 500 mg | N | Y | N | |
| 29300038901 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 29300038905 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 33342023944 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42385097701 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42385097705 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42385097711 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42385097790 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42806063201 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 42806063205 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 49483062301 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 49483062309 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 49483062310 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 49483062350 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 50268055011 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 50268055015 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 60687064001 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 60687064011 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 62756014201 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 62756014202 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877015901 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877015905 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877015910 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877041301 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877041305 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 67877041390 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 68094090450 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 68094090460 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 68645059559 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 69238212507 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 69315041001 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 69315041005 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 70010049101 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 70010049105 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 70010049109 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 70010049110 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 76385012810 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 82009011710 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 500 mg | Y | Y | N | |
| 29300039901 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 42385097801 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 42806063301 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 49483062401 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 49483062450 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 50268055111 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 50268055115 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 62756014301 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 67877041401 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 68094080450 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 68094080460 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 69238212601 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 70010049201 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 70010049210 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 72578003601 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 76385012901 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 76385012950 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 82009011801 | METFORMIN HCL ER | metformin HCl | TAB ER 24H | 750 mg | Y | Y | N | |
| 27241024190 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 42571033490 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 47335030688 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 50228044690 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 60505470109 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 68180033909 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 68462052190 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 70010049709 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 1,000 mg | N | Y | N | |
| 27241024001 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 42571033301 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 47335030588 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 50228044501 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 60505470001 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 68180033801 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 68462052001 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 70010049601 | METFORMIN ER GASTRIC | metformin HCl | TABERGR24H | 500 mg | N | Y | N | |
| 00378718705 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 00904560389 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 00904716461 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 23155084301 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 23155084305 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 23155084310 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 42385094901 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 42385094905 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 42385094911 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 43547035910 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 43547035950 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 49483062001 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 49483062010 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 49483062050 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 49483062081 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 50228010701 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 50228010705 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 50228010710 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 50228010730 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 57664047488 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 59651085601 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 59651085605 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 59651085699 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 60687016201 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 60687016211 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 62135068405 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 62135068418 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 62135068490 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 65862001001 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 65862001005 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 65862001046 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 65862001099 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 67877056301 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 67877056305 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 67877056310 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 67877093205 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68094048060 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68094048070 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68382076001 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68382076005 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68382076010 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68462016118 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68645030059 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68645054559 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 68645058459 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367018201 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367018205 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367018210 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367038301 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367038305 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 69367038310 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 70010006501 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 70010006505 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 70010006509 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 70010006510 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 70010006599 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 71093013404 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 71093013405 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 82009004710 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 82009017510 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 83301001001 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 83301001002 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 83301001003 | METFORMIN HCL | metformin HCl | TABLET | 1,000 mg | Y | Y | N | |
| 00378718505 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 00904716261 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 23155010206 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 23155084101 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 23155084105 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 23155084110 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 42385094701 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 42385094705 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 42385094711 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 42806021305 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 43547035710 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 43547035711 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 43547035750 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 49483062201 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 49483062210 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 49483062250 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 49483062281 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 50228010501 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 50228010505 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 50228010510 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 50228010530 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 59651085401 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 59651085405 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 59651085499 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 60687015501 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 60687015511 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 62135068005 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 62135068018 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 62135068090 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 65862000801 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 65862000805 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 65862000899 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 67877056101 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 67877056105 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 67877056110 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 67877093001 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 67877093005 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68094068860 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68094068870 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68382075801 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68382075805 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68382075810 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68645054459 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 68645058259 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367018001 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367018005 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367018010 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367038101 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367038105 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 69367038110 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 70010006301 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 70010006305 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 70010006309 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 70010006310 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 71093013204 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 71093013205 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 71093013206 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 82009004610 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 82009017410 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 83301000801 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 83301000802 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 83301000803 | METFORMIN HCL | metformin HCl | TABLET | 500 mg | Y | Y | N | |
| 62135068130 | METFORMIN HCL | metformin HCl | TABLET | 625 mg | Y | N | ||
| 72336006430 | METFORMIN HCL | metformin HCl | TABLET | 625 mg | Y | N | ||
| 62135068230 | METFORMIN HCL | metformin HCl | TABLET | 750 mg | N | Y | N | |
| 72336009530 | METFORMIN HCL | metformin HCl | TABLET | 750 mg | N | Y | N | |
| 00378718605 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 00904716361 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 23155010306 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 23155084201 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 23155084205 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 23155084210 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 42385094801 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 42385094805 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 42385094811 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 43547035810 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 43547035850 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 49483062101 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 49483062110 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 49483062150 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 49483062181 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 50228010601 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 50228010605 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 50228010630 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 59651085501 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 59651085505 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 60687014301 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 60687014311 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 62135068318 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 62135068330 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 62135068390 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 65862000901 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 65862000905 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 67877056201 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 67877056205 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 67877056210 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 67877093101 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68094058060 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68094058070 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68382075901 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68382075905 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68382075910 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68645054759 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 68645058359 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367018101 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367018105 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367038201 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367038205 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367038210 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 70010006401 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 70010006405 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 70010006409 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 70010006410 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 70010006499 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 71093013304 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 71093013305 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 83301000901 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 83301000902 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 83301000903 | METFORMIN HCL | metformin HCl | TABLET | 850 mg | Y | Y | N | |
| 69367030501 | MIGLITOL | miglitol | TABLET | 100 mg | N | Y | N | |
| 69367030301 | MIGLITOL | miglitol | TABLET | 25 mg | N | Y | N | |
| 69367030401 | MIGLITOL | miglitol | TABLET | 50 mg | N | Y | N | |
| 00591335501 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 16571075909 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 55111032990 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 60687068411 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 60687068421 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 64380016802 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 68382072216 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 72241000304 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 72241000305 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 75834020601 | NATEGLINIDE | nateglinide | TABLET | 120 mg | N | Y | N | |
| 16571075809 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 55111032890 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 60687067311 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 60687067321 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 64380016702 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 68382072116 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 72241000204 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 72241000205 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 75834020501 | NATEGLINIDE | nateglinide | TABLET | 60 mg | N | Y | N | |
| 00310661502 | SYMLINPEN 60 | pramlintide acetate | PEN INJCTR | 1,500 mcg/1.5 mL | N | Y | N | |
| 00310662702 | SYMLINPEN 120 | pramlintide acetate | PEN INJCTR | 2,700 mcg/2.7 mL | N | Y | N | |
| 33342024811 | REPAGLINIDE | repaglinide | TABLET | 0.5 mg | N | Y | N | |
| 57237015701 | REPAGLINIDE | repaglinide | TABLET | 0.5 mg | N | Y | N | |
| 62135094690 | REPAGLINIDE | repaglinide | TABLET | 0.5 mg | N | Y | N | |
| 65862067001 | REPAGLINIDE | repaglinide | TABLET | 0.5 mg | N | Y | N | |
| 72603081001 | REPAGLINIDE | repaglinide | TABLET | 0.5 mg | N | Y | N | |
| 33342024911 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 57237015801 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 57664074513 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 57664074588 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 60687056011 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 60687056021 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 62135094790 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 65862067101 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 72603081101 | REPAGLINIDE | repaglinide | TABLET | 1 mg | N | Y | N | |
| 33342025011 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 57237015901 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 57664074713 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 57664074788 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 62135094890 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 65862067201 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 72603081201 | REPAGLINIDE | repaglinide | TABLET | 2 mg | N | Y | N | |
| 73650031601 | TZIELD | teplizumab-mzwv | VIAL | 2 mg/2 mL (1 mg/mL) | N | Y | N | Pharmacy PA |
| 73650031610 | TZIELD | teplizumab-mzwv | VIAL | 2 mg/2 mL (1 mg/mL) | N | Y | N | Pharmacy PA |
| 73650031614 | TZIELD | teplizumab-mzwv | VIAL | 2 mg/2 mL (1 mg/mL) | N | Y | N | Pharmacy PA |