Drug Name Tier Notes LITETOUCH INSULIN SYRINGE 3 ST; QL LITETOUCH PEN NEEDLES 3 ST; QL MAGELLAN INSULIN SAFETY SYR 3 ST; QL MARATHON MEDICAL PENTIPS 3 ST; QL MAXICOMFORT II PEN NEEDLE 3 ST; QL MAXI-COMFORT INSULIN SYRINGE 3 ST; QL MAXI-COMFORT SAFETY PEN NEEDLE 3 ST; QL MAXICOMFORT SYR 27G X 1/2" 3 ST; QL MEDIC INSULIN SYRINGE 3 ST; QL MEDICINE SHOPPE PEN NEEDLES 29G X 12MM , 31G X 8 MM 3 ST; QL MEIJER PEN NEEDLES 3 ST; QL MICRODOT PEN NEEDLE 3 ST; QL MM INSULIN SYRINGE/NEEDLE 3 ST; QL MM PEN NEEDLES 3 ST; QL MONOJECT INSULIN SYRINGE 3 ST; QL MONOJECT ULTRA COMFORT 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 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 31G X 5/16" 0.3 ML, 31G X 5/16" 0.5 ML 3 ST; QL NOVOFINE PEN NEEDLE 3 ST; QL NOVOFINE PLUS PEN NEEDLE 3 ST; QL PC UNIFINE PENTIPS 31G X 5 MM , 31G X 6 MM , 31G X 8 MM 3 ST; QL pen needle/5-bevel tip 3 ST; QL PEN NEEDLES 3 ST; QL Drug Name Tier Notes PENTIPS 29G X 12MM , 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 32G X 6 MM 3 ST; QL PENTIPS GENERIC PEN NEEDLES 3 ST; QL pip pen needles 31g x 5mm 3 ST; QL pip pen needles 32g x 4mm 3 ST; QL PRECISION SURE-DOSE SYRINGE 30G X 5/16" 0.3 ML 3 ST; QL PREFERRED PLUS UNIFINE PENTIPS 29G X 12MM 3 ST; QL PREVENT DROPSAFE PEN NEEDLES 3 ST; QL PREVENT SAFETY PEN NEEDLES 3 ST; QL PRO COMFORT INSULIN SYRINGE 3 ST; QL PRO COMFORT PEN NEEDLES 32G X 4 MM , 32G X 5 MM , 32G X 6 MM 3 ST; QL PRODIGY INSULIN SYRINGE 3 ST; QL PURE COMFORT PEN NEEDLE 3 ST; QL pure comfort safety pen needle 3 QL PX INSULIN SYRINGE 30G X 1/2" 0.5 ML 3 ST; QL PX MINI PEN NEEDLES 3 ST; QL QC PEN NEEDLES 3 ST; QL QC UNIFINE PENTIPS 3 ST; QL QUICK TOUCH INSULIN PEN NEEDLE 31G X 4 MM , 31G X 5 MM , 32G X 4 MM , 32G X 5 MM , 32G X 6 MM , 32G X 8 MM , 33G X 4 MM , 33G X 5 MM , 33G X 6 MM , 33G X 8 MM 3 ST; QL RA INSULIN SYRINGE 3 ST; QL RA PEN NEEDLES 3 ST; QL raya sure pen needle 3 ST; QL REALITY INSULIN SYRINGE 3 ST; QL * Your plan may include Tiers 1a/1b. Refer to your pharmacy benefit summary for more information. Effective 08012025 67