Drug Name Tier Notes EMBECTA INSULIN SYRINGE U-500 2 QL EMBECTA PEN NEEDLE NANO 2 QL EMBECTA PEN NEEDLE NANO 2 GEN 2 QL EMBECTA PEN NEEDLE ULTRAFINE 2 QL EMBRACE PEN NEEDLES 3 ST; QL FIFTY50 PEN NEEDLES 3 ST; QL FIFTY50 SUPERIOR COMFORT SYR 3 ST; QL GLOBAL EASE INJECT PEN NEEDLES 3 ST; QL GLOBAL EASY GLIDE INSULIN SYR 3 ST; QL GLOBAL EASY GLIDE PEN NEEDLES 3 ST; QL GLOBAL INJECT EASE INSULIN SYR 3 ST; QL GLOBAL INSULIN SYRINGES 3 ST; QL GLUCOPRO INSULIN SYRINGE 3 ST; QL GNP INSULIN SYRINGE 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML 3 ST; QL GNP INSULIN SYRINGES 3 ST; QL GNP INSULIN SYRINGES 28GX1/2" 3 ST; QL GNP INSULIN SYRINGES 29GX1/2" 3 ST; QL GNP INSULIN SYRINGES 30GX5/16" 3 ST; QL GNP INSULIN SYRINGES 31GX5/16" 3 ST; QL gnp pen needles 3 ST; QL GNP ULTICARE PEN NEEDLES 3 ST; QL GNP ULTIGUARD SAFEPACK NEEDLE 3 ST; QL GNP ULTRA COM INSULIN SYRINGE 28G X 1/2" 1 ML 3 ST; QL HEALTHWISE INSULIN SYR/NEEDLE 3 ST; QL HEALTHWISE MICRON PEN NEEDLES 3 ST; QL Drug Name Tier Notes HEALTHWISE SHORT PEN NEEDLES 3 ST; QL H-E-B INCONTROL PEN NEEDLES 3 ST; QL H-E-B INCONTROL UNIFINE PENTIP 3 ST; QL HM ULTICARE INSULIN SYRINGE 3 ST; QL HM ULTICARE MINI PEN NEEDLES 3 ST; QL HM ULTICARE SHORT PEN NEEDLES 3 ST; QL INCONTROL ULTICARE PEN NEEDLES 3 ST; QL INSULIN SYRINGE 28G X 1/2" 0.5 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML 3 ST; QL insulin syringe-needle u-100 27g x 1/2" 0.5 ml, 27g x 1/2" 1 ml, 28g x 1/2" 0.5 ml, 28g x 1/2" 1 ml, 30g x 1/2" 1 ml 3 ST; QL INSULIN SYRINGE- NEEDLE U-100 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML 3 ST; QL INSUPEN PEN NEEDLES 29G X 12MM , 31G X 5 MM , 31G X 8 MM , 32G X 4 MM 3 ST; QL INSUPEN32G EXTR3ME 3 KINRAY INSULIN SYRINGE 29G X 1/2" 0.5 ML 3 ST; QL KROGER PEN NEEDLES 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 33G X 4 MM 3 ST; QL LEADER UNIFINE PENTIPS 3 ST; QL LEADER UNIFINE PENTIPS PLUS 3 ST; QL * Your plan may include Tiers 1a/1b. Refer to your pharmacy benefit summary for more information. Effective 08012025 66