Skip to Main Content

Medicare 2024 Diabetes Prescribing Aid

Date: 05/28/24

2024 Diabetes Prescribing Aid MAPD: D-SNP, C-SNP, & PPO

Benefits subject to evidence of coverage. Information on copays/cost sharing, deductibles, and gap coverage can be found in the Summary of Benefits on our website:

H0351, H5590: Wellcare By Allwell                  H8553: Wellcare

2024 Preferred Insulin Products  
Fast Acting
  • Fiasp (insulin aspart)
  • Novolog
Short Acting
  •  Novolin R (Note: Brand RELION is not covered).
Intermediate Acting
  • Novolin N (Note: Brand RELION is not covered)
Long Actiing
  • Basaglar (insulin glargine).
  • Tresiba (insulin degludec)
  • Toujeo (insulin glargine).
  • Toujeo Max (insulin glargine)
Combinations

Insulins

  • Novolog Mix 70/30.
  • Novolin 70/30

Insulin + GLP-1 receptor agonist

  • Soliqua (insulin glargine + lixisenatide), Xultophy (insulin degludec+ liraglutide)
  •  C-SNP plans (Wellcare Specialty No Premium HMO C-SNP): Tier 6, $0 or low copay 
  • D -SNP plans (Wellcare Dual Liberty HMO D-SNP): Tier 1, $0 or low copay.
  • All other plans: Tier 3 with maximum copay of $35 per month based on Inflation Reduction Act
 

For more than 20 years, Wellcare has ofered a range of Medicare products, which ofer afordable coverage beyond OriginalMedicare. Beginning Jan. 1, 2022, our afliated Medicare brands, including Allwell, transitioned to a newly refreshed and unifid Wellcare brand. If you have any questions, please contact Provider Relations.

2024 Preferred Anti-Diabetic (non-insulin) Medications

GENERIC ORAL ANTI-DIABETIC MEDICATIONS:

  • Biguanide: metformin, metformin ER (generic for Glucophage XR only).
  • Thiazolidinedione: pioglitazone.•  Alpha-Glucosidase inhibitor: acarbose.
  • Meglitinide analogue: nateglinide, repaglinide.
  • Combinations: glipizide/metformin, pioglitazone/metformin, pioglitazone/glimepiride.
  • C-SNP plans (Wellcare Specialty No Premium HMO C-SNP): Tier 1, $0 or low copay. 
  • D-SNP plans (Wellcare Dual Liberty HMO D-SNP): Tier 1, $0 or low copay. 
  • All other plans: Tier 6, $0 or low copay.

 

DPP-4 INHIBITOR:    

  • Januvia, Tradjenta

DPP-4 COMBINATIONS:

  • Glyxambi, Janumet, Janumet XR,Jentodueto, Jentodueto XR, Trijardy.
  • C-SNP plans (Wellcare Specialty No Premium HMO C-SNP): Tier 6, $0 or low copay, EXCEPT Glyxambi and Trijardy, which are Tier 3. 
  • D-SNP plans (Wellcare Dual Liberty HMO D-SNP): Tier 1, $0 or low copay. 
  • All other plans: Tier 3.

 

SGLT-2 INHIBITOR:

  • Farxiga, Jardiance, Invokana.

SGLT-2 INHIBITOR COMBINATION:

  • Glyxambi, Synjardy, Synjardy XR, Trijardy,Xigduo, Invokamet*, Invokamet XR.*
  •  *Invokana, Invokamet, and Invokamet XR: NONFORMULARY for D-SNP plans (Wellcare DualLiberty HMO D-SNP) and Tier 4 for all other plans.
  • Farxiga,  Jardiance – Tier 1, $0 or low copay, for D-SNP plans (Wellcare Dual Liberty HMO D-SNP),and Tier 3 for all other plans.

GLP-1 AGONIST:

  • Bydureon, Ozempic, Mounjaro, Rybelsus, Trulicity.
  • D -SNP plans (Wellcare Dual Liberty HMO D-SNP): Tier 1, $0 or low copay.  
  • All other plans: Tier 3. 
  • All plans require prior authorization.

 

2024 Preferred Blood Glucose Meters and Strips

One Touch Verio Reflect or Verio Flex meter and One Touch Verio test strips; One Touch Ultra 2meter and One Touch Ultra test strips

Test Strip Quantity Limits:

  • Non-insulin users: 100 strips/90 days
  • Insulin  users: 100 strips/25 days
Note: Continuous Glucose Monitoring (CGM) systems require Prior Authorization(PA). FreeStyle Libre or DexCom are preferred/PA required. PA criteria: DM diagnosis, insulin-treated, has had more than one level 2 hypoglycemic event (BG < 54 mg/dL) that persists despite more than one attempt toadjust medications and/or modify diabetes treatment plan OR one level 3 hypoglycemic event (BG< 54 mg/dL) characterized by altered mental and/or physical state requiring third-party assistancefor treatment, seen by provider in last six months, and will have follow-up appointments every sixmonths to document adherence to both the CGM regimen and diabetes treatment plan. The CoverageDetermination form for PA request is available on our website.