Drug Name Tier Notes RELION INSULIN SYRINGE 29G X 1/2" 0.5 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 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 RELION PEN NEEDLES 31G X 6 MM , 31G X 8 MM , 32G X 4 MM 3 ST; QL safety pen needles 3 ST; QL SB INSULIN SYRINGE 3 ST; QL SECURESAFE INSULIN SYRINGE 3 ST; QL SECURESAFE SAFETY PEN NEEDLES 3 ST; QL SURE COMFORT INSULIN SYRINGE 3 ST; QL SURE COMFORT PEN NEEDLES 29G X 12.7MM , 30G X 8 MM , 31G X 5 MM , 31G X 8 MM , 32G X 4 MM , 32G X 6 MM 3 ST; QL sure comfort pen needles 31g x 6 mm 3 ST; QL TECHLITE INSULIN SYRINGE 30G X 1/2" 1 ML, 31G X 15/64" 0.3 ML, 31G X 15/64" 0.5 ML, 31G X 15/64" 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 TECHLITE PEN NEEDLES 29G X 12MM , 31G X 5 MM 3 TECHLITE PEN NEEDLES 31G X 8 MM , 32G X 4 MM , 32G X 6 MM 3 ST; QL TECHLITE PLUS PEN NEEDLES 3 TODAYS HEALTH PEN NEEDLES 3 ST; QL TODAYS HEALTH SHORT PEN NEEDLE 3 ST; QL true comfort insulin syringe 30g x 1/2" 0.5 ml, 30g x 1/2" 1 ml, 30g x 5/16" 0.5 ml, 30g x 5/16" 1 ml, 32g x 5/16" 1 ml 3 ST; QL Drug Name Tier Notes TRUE COMFORT INSULIN SYRINGE 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML 3 ST; QL TRUE COMFORT PEN NEEDLES 3 ST; QL TRUE COMFORT PRO INSULIN SYR 3 ST; QL TRUE COMFORT PRO PEN NEEDLES 3 ST; QL true comfort safety pen needle 3 ST; QL TRUEPLUS 5-BEVEL PEN NEEDLES 29G X 12.7MM 3 QL TRUEPLUS 5-BEVEL PEN NEEDLES 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM 3 ST; QL TRUEPLUS INSULIN SYRINGE 3 ST; QL ULTICARE INSULIN SAFETY SYR 3 ST; QL ULTICARE INSULIN SYR 1/2 UNIT 3 ST; QL ULTICARE INSULIN SYRINGE 3 ST; QL ULTICARE MICRO PEN NEEDLES 3 ST; QL ULTICARE MINI PEN NEEDLES 3 ST; QL ULTICARE PEN NEEDLES 29G X 12.7MM , 31G X 5 MM 3 ST; QL ULTICARE SHORT PEN NEEDLES 3 ST; QL ULTIGUARD SAFEPACK PEN NEEDLE 3 ST; QL ULTIGUARD SAFEPACK SYR/NEEDLE 3 ST; QL ULTILET PEN NEEDLE 3 ST; QL ULTRA COMFORT INSULIN SYRINGE 30G X 5/16" 0.3 ML 3 ST; QL ULTRA FLO INSULIN PEN NEEDLES 3 ST; QL ULTRA FLO INSULIN SYR 1/2 UNIT 3 ST; QL ULTRA FLO INSULIN SYRINGE 3 ST; QL * Your plan may include Tiers 1a/1b. Refer to your pharmacy benefit summary for more information. Effective 08012025 68