SYNJARDY XR TAB 10-1000mg, 25- 1000mg SYNJARDY XR TAB 5-1000mg, 12.5- 1000mg TOLBUTAMIDE TAB TOUJEO MAX SOLOSTAR INJ TOUJEO SOLOSTAR INJ TRADJENTA TAB TRESIBA FLEXTOUCH INJ TRESIBA INJ TRIJARDY XR TAB 10-5-1000mg, 25-5- 1000mg TRIJARDY XR TAB 5-25-1000mg, 12.5-2.5- 1000mg TRULICITY INJ VICTOZA INJ XIGDUO XR TAB 2.5-1000mg, 5-1000mg XIGDUO XR TAB 5-500mg, 10-500mg, 10- 1000mg XULTOPHY INJ ZEGALOGUE INJ DIABETIC SUPPLIES Tier 1 Tier 2 Tier 3 B-D INSULIN SYRINGE ACCU-CHEK AVIVA PLUS TEST STRIP B-D PEN NEEDLE ACCU-CHEK GUIDE TEST STRIP CALIBRATION LIQUID ACCU-CHEK SMARTVIEW TEST STRIP CLINISTIX TEST STRIP ACCU-CHEK TEST STRIP KETO-DIASTIX TEST STRIP DEXCOM G7 RECEIVER KETOSTIX DEXCOM G7 SENSOR LANCET DEVICE DEXCOM G6 RECEIVER LANCET KIT DEXCOM G6 SENSOR LANCET DEXCOM G6 TRANSMITTER NOVOFINE PEN NEEDLE FREESTYLE LIBRE 2 RECEIVER Page 4 of 10