Drug Name Tier Notes aqinject pen needle 3 ST; QL ASSURE ID DUO PRO PEN NEEDLES 3 QL ASSURE ID PRO PEN NEEDLES 3 QL ASSURE ID SAFETY PEN NEEDLES 30G X 8 MM 3 ST; QL aum insulin safety pen needle 3 ST; QL AUM MINI INSULIN PEN NEEDLE 3 ST; QL aum pen needle 3 ST; QL AUM READYGARD DUO PEN NEEDLE 3 ST; QL AUM SAFETY PEN NEEDLE 3 ST; QL AURORA PEN NEEDLES 3 ST; QL BD AUTOSHIELD DUO 2 QL BD INS SYR ULTRAFINE 1/2UNIT 2 QL BD INSULIN SYR ULTRAFINE II 31G X 5/16" 0.3 ML 2 QL BD INSULIN SYRINGE 27.5G X 5/8" 2 ML, 27G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, U-100 1 ML 2 QL BD INSULIN SYRINGE HALF-UNIT 2 QL BD INSULIN SYRINGE MICROFINE 27G X 5/8" 1 ML, 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML 2 QL BD INSULIN SYRINGE U/F 30G X 1/2" 1 ML 2 QL BD INSULIN SYRINGE U-500 2 QL BD INSULIN SYRINGE ULTRAFINE 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G X 1/2" 1 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML 2 QL BD PEN NEEDLE MICRO ULTRAFINE 2 QL BD PEN NEEDLE MINI ULTRAFINE 2 QL Drug Name Tier Notes BD PEN NEEDLE NANO 2ND GEN 2 QL BD PEN NEEDLE NANO ULTRAFINE 2 QL BD PEN NEEDLE ORIG ULTRAFINE 2 QL BD PEN NEEDLE SHORT ULTRAFINE 2 QL BD SAFETYGLIDE INSULIN SYRINGE 2 QL BD VEO INSULIN SYR U/F 1/2UNIT 2 QL BD VEO INSULIN SYR ULTRAFINE 2 QL CAREFINE PEN NEEDLES 3 ST; QL CAREONE INSULIN SYRINGE 3 ST; QL CAREONE UNIFINE PENTIPS PLUS 3 ST; QL CARETOUCH INSULIN SYRINGE 3 ST; QL CARETOUCH PEN NEEDLES 3 ST; QL CLEVER CHOICE COMFORT EZ 29G X 12MM , 33G X 4 MM 3 ST; QL COMFORT EZ INSULIN SYRINGE 28G X 1/2" 0.5 ML, 28G X 1/2" 1 ML, 29G X 1/2" 0.3 ML, 29G X 1/2" 0.5 ML, 29G X 1/2" 1 ML, 30G X 1/2" 0.3 ML, 30G X 1/2" 0.5 ML, 30G 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 COMFORT EZ INSULIN SYRINGE 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 1 ML 3 QL COMFORT EZ MICRO PEN NEEDLES 3 ST; QL COMFORT EZ PEN NEEDLES 3 ST; QL COMFORT EZ PRO PEN NEEDLES 30G X 8 MM , 31G X 4 MM 3 ST; QL * Your plan may include Tiers 1a/1b. Refer to your pharmacy benefit summary for more information. Effective 08012025 64