Lista de medicamentos con receta Standard de 4 niveles de Cigna Healthcare Los medicamentos de especialidad están cubiertos en el Nivel 4 (la lista está en las páginas 17-20).
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DIABETES (cont.) FREESTYLE LIBRE 14 DAY READER, SENSOR (PA, QL) FREESTYLE LIBRE 2 READER, SENSOR (PA, QL) FREESTYLE LIBRE 3 READER, SENSOR (PA, QL) GLUCAGEN VIAL GLUCAGEN HYPOKIT (QL) GLYXAMBI (QL, ST) HUMALOG (QL) HUMULIN 70/30, HUMULIN N, HUMULIN R (QL) INSULIN GLARGINE- YFGN (QL) INSULIN LISPRO (QL) INSULIN LISPRO KWIKPEN (QL) INSULIN LISPRO PROTAMINE MIX (QL) JANUMET (QL, ST) JANUMET XR (QL, ST) JANUVIA (QL, ST) JARDIANCE (QL, ST) LYUMJEV (QL) LYUMJEV TEMPO PEN U-100 (QL) MOUNJARO (PA, QL) OMNIPOD 5 G6 INTRO KIT (GEN 5) (QL)
vyfemla+ vylibra+ wera+ WIDE SEAL DIAPHRAGM+ wymzya fe+ xulane+ zafemy+ zarah+ zovia 1-35+ zumandimine+
CARETOUCH INSULIN SYRINGE CARETOUCH INSULIN SYRINGE COMFORT EZ INSULIN SYRINGE DROPLET GENTEEL LANCING DEVICE DROPLET INSULIN SYRINGE EASY COMFORT INSULIN SYRINGE EASY GLIDE INSULIN SYRINGE EASY TOUCH INSULIN SAFETY EASY TOUCH INSULIN SYRINGE EASY TOUCH LUER LOCK INSULIN EASY TOUCH SHEATHLOCK INSULIN EASY TOUCH UNI- SLIP SYRINGE 1 ML EASY-TOUCH INSULIN SYRINGE FREESTYLE PRECISION GUARDIAN RT CHARGER GUARDIAN TEST PLUG HEALTHWISE INSULIN SYRINGE INPEN (FOR HUMALOG) INPEN (FOR NOVOLOG OR FIASP) INSULIN SYRINGE LITETOUCH INSULIN SYRINGE MAGELLAN INSULIN SYRINGE MAXICOMFORT INSULIN SYRINGE metformin 500 mg, 850 mg, 1,000 mg tablet
MEDICAMENTOS PARA LA TOS/EL RESFRÍO
brompheniramine- pseudoephedrine -dm hydrocodone- chlorpheniramine er (PA) promethazine-dm
TUZISTRA XR (PA, QL)
PRODUCTOS DENTALES
chlorhexidine doxycycline hyclate FLUORIDEX DAILY DEFENSE 1.1% oralone periogard triamcinolone
PREVIDENT 0.2% RINSE
CLINPRO 5000 FLORIVA 0.25 MG/ ML DROPS+^ FLUORIDEX SENSITIVITY RELIEF JUST RIGHT 5000 PERIDEX PREVIDENT 1.1% GEL PREVIDENT 5000 CYCLOSET GLUCAGON EMERGENCY KIT (QL)
DIABETES
ACCU-CHEK ACCU-CHEK
BAQSIMI (QL) BYDUREON BCISE (PA, QL) BYETTA (PA, QL) CEQUR SIMPLICITY CEQUR SIMPLICITY INSERTER DEXCOM G6 RECEIVER (PA, QL) DEXCOM G6 SENSOR (PA, QL) DEXCOM G6 TRANSMITTER (PA, QL) DEXCOM G7 RECEIVER (PA, QL) DEXCOM G7 SENSOR (PA, QL) FARXIGA (QL, ST)
CONTROL SOLUTION ACCU-CHEK FASTCLIX LANCING DEVICE ADVOCATE SYRINGE ASSURE ID INSULIN SAFETY AUTOSHIELD DUO PEN NEEDLE BD INSULIN PEN NEEDLE, SYRINGE BD ECLIPSE 30GX1/2" SYRINGE BD LUER-LOK SYRINGE 1 ML
GVOKE (QL) ULTIGUARD SAFEPACK SYRINGE
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