Drug Name Tier Notes COMFORT EZ PRO PEN NEEDLES 31G X 5 MM 3 QL COMFORT EZ SHORT PEN NEEDLES 3 ST; QL COMFORT TOUCH INSULIN PEN NEED 3 ST; QL DIATHRIVE PEN NEEDLE 3 ST; QL DROPLET INSULIN SYRINGE 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 15/64" 0.3 ML, 30G X 15/64" 1 ML, 30G X 5/16" 0.3 ML, 30G X 5/16" 0.5 ML, 30G X 5/16" 1 ML, 31G X 1/4" 0.3 ML, 31G X 1/4" 0.5 ML, 31G X 1/4" 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 DROPLET INSULIN SYRINGE 30G X 15/64" 0.5 ML 3 QL DROPLET MICRON 3 QL DROPLET PEN NEEDLES 3 ST; QL DROPSAFE SAFETY PEN NEEDLES 3 ST; QL DROPSAFE SAFETY SYRINGE/NEEDLE 3 ST; QL DRUG MART UNIFINE PENTIPS 29G X 12MM , 31G X 6 MM , 31G X 8 MM 3 ST; QL DRUG MART UNIFINE PENTIPS PLUS 3 ST; QL easy comfort insulin syringe 29g x 5/16" 0.5 ml, 29g x 5/16" 1 ml, 31g x 1/2" 0.3 ml, 31g x 5/16" 0.3 ml 3 ST; QL EASY 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, 31G X 5/16" 0.5 ML, 31G X 5/16" 1 ML, 32G X 5/16" 0.5 ML, 32G X 5/16" 1 ML 3 ST; QL Drug Name Tier Notes easy comfort pen needles 29g x 4mm , 29g x 5mm 3 ST; QL EASY COMFORT PEN NEEDLES 31G X 5 MM , 31G X 6 MM , 31G X 8 MM , 32G X 4 MM , 33G X 4 MM , 33G X 5 MM , 33G X 6 MM 3 ST; QL EASY GLIDE PEN NEEDLES 3 ST; QL EASY TOUCH FLIPLOCK INSULIN SY 3 ST; QL EASY TOUCH INSULIN BARRELS 3 ST; QL EASY TOUCH INSULIN SAFETY SYR 3 ST; QL EASY TOUCH INSULIN SYRINGE 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, 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 EASY TOUCH INSULIN SYRINGE 27G X 5/8" 1 ML 3 QL EASY TOUCH PEN NEEDLES 3 ST; QL EASY TOUCH SAFETY PEN NEEDLES 3 ST; QL EASY TOUCH SHEATHLOCK SYRINGE 29G X 1/2" 1 ML, 30G X 1/2" 1 ML, 30G X 5/16" 1 ML, 31G X 5/16" 1 ML 3 ST; QL EMBECTA AUTOSHIELD DUO 2 QL EMBECTA INS SYR U/F 1/2 UNIT 2 QL EMBECTA INSULIN SYR ULTRAFINE 2 QL EMBECTA INSULIN SYRINGE 2 QL EMBECTA INSULIN SYRINGE U-100 2 QL * Your plan may include Tiers 1a/1b. Refer to your pharmacy benefit summary for more information. Effective 08012025 65