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CRP1386903A 204612 EXCL-NPF-26 (08/08/2025) Page 9 Drug Class Excluded Medications Preferred Alternatives DIABETES (continued) Glucose-Elevating Drugs GLUCAGEN HYPOKIT, GLUCAGON EMERGENCY KIT (by Fresenius), ZEGALOGUE glucagon emergency kit (by Amphastar), BAQSIMI, GVOKE Insulin (Basal) & Glucagon-Like Peptide-1 (GLP-1) Agonist Combinations XULTOPHY SOLIQUA U-100: HUMALOG (CARTRIDGE, KWIKPEN, JUNIOR KWIKPEN), HUMALOG TEMPO, INSULIN LISPRO, LYUMJEV KWIKPEN & VIAL, LYUMJEV TEMPO U-200: HUMALOG KWIKPEN, LYUMJEV KWIKPEN U-100: ADMELOG, APIDRA, FIASP, HUMALOG VIAL, INSULIN ASPART, NOVOLOG, RELION NOVOLOG Inhalation: AFREZZA U-100: BASAGLAR, BASAGLAR TEMPO, INSULIN DEGLUDEC, INSULIN GLARGINE, LANTUS, LEVEMIR, REZVOGLAR U-100: INSULIN GLARGINE-YFGN, SEMGLEE (YFGN), TRESIBA Insulins U-200: TRESIBA U-300: TOUJEO U-200: INSULIN DEGLUDEC U-300: INSULIN GLARGINE INSULIN ASPART PROTAMINE, NOVOLOG MIX, RELION NOVOLOG MIX NOVOLIN, NOVOLIN MIX, RELION NOVOLIN, RELION NOVOLIN MIX BRENZAVVY, DAPAGLIFLOZIN, INVOKANA, STEGLATRO DAPAGLIFLOZIN/METFORMIN ER, INVOKAMET, INVOKAMET XR, SEGLUROMET HUMALOG MIX, INSULIN LISPRO PROTAMINE MIX HUMULIN, HUMULIN MIX FARXIGA, JARDIANCE Sodium Glucose Co-Transporter-2 (SGLT-2) Inhibitors & Combinations SYNJARDY, SYNJARDY XR, XIGDUO XR GLIMEPIRIDE 3MG TABLETS GLIPIZIDE 2.5MG TABLETS glimepiride 1mg, 2mg or 4mg tablets Sulfonylurea Agents glipizide 5mg tablets EAR/NOSE Nasal Antihistamines & Combination Products azelastine/fluticasone, DYMISTA azelastine nasal plus fluticasone nasal Nasal Steroids BECONASE AQ, OMNARIS, QNASL, ZETONNA flunisolide, fluticasone, mometasone, XHANCE CETRAXAL ciprofloxacin otic, ofloxacin otic Otic Antibiotics & Combination Products CIPRO HC, CIPROFLOXACIN/FLUOCINOLONE OTIC ciprofloxacin/dexamethasone otic ketoconazole tablets, mifepristone 300mg, SIGNIFOR ISTURISA ENDOCRINE Cushings Agents RECORLEV ketoconazole tablets Gonadotropin-Releasing Hormone (GnRH) Analogs (for Central Precocious Puberty) LUPRON DEPOT-PED FENSOLVI, SUPPRELIN LA, TRIPTODUR HUMATROPE, NORDITROPIN FLEXPRO, NUTROPIN AQ NUSPIN, SAIZEN, SAIZENPREP, ZOMACTON GENOTROPIN, OMNITROPE Growth Hormones SKYTROFA, SOGROYA GENOTROPIN, OMNITROPE, NGENLA LANREOTIDE, SANDOSTATIN LAR DEPOT SOMATULINE DEPOT Somatostatin Analogs For Acromegaly: SOMATULINE DEPOT For Cushings Disease: SIGNIFOR SIGNIFOR LAR (continued) 2025 Evernorth Health Services
In a 2013 study, researchers gave testosterone injections to 19 men with testosterone deficiency and transdermal testosterone gel to 7 men with low testosterone
