|
|
|
Y42.3 |
| Acarbose |
25 mg, 50mg, 100mg |
Tablet |
Y42.3 |
| Accu-Chek Active Test Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Advantage Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Aviva Test Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Comfort Curve Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Compact Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Complete Test Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Easy Test Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Instant Test Strips |
|
Test Strips |
Y42.3 |
| Accu-Chek Simplicity Strips |
|
Test Strips |
Y42.3 |
| Acebutolol |
200 mg |
Capsules |
Y42.3 |
| Acetohexamide |
250mg, 500mg |
Tablet |
Y42.3 |
| Chlorpropamide |
100mg, 250mg |
Tablet |
Y42.3 |
| Ertugliflozin |
5 mg, 15 mg |
Tablet |
|
| Exenatide |
2mg |
Injection |
Y42.3 |
| Glibenclamide |
2.5 mg, 5 mg |
Tablet |
|
| Glibenclamide and Metformin |
2.5mg/400mg, 5mg/500mg, 2.5mg/250mg, 1.25mg/250mg, 2.5mg/500mg |
Tablet |
Y42.3 |
| Gliclazide |
40mg, 80mg, 30mg, 160mg, 60mg, |
Tablet |
Y42.3 |
| Glimepride |
1mg, 2mg, 4mg |
Tablet |
Y42.3 |
| Glipizide |
5mg, 10mg |
Tablet |
Y42.3 |
| Glipizide and Metformin |
2.5 mg/250 mg, 2.5 mg/500 mg, 5 mg/500 mg |
Tablets |
Y42.3 |
| Glipizide, Extended Release |
2.5mg, 5mg, 10mg |
Tablet |
Y42.3 |
| Glipizide/Metformin |
2.5-250, 2.5-500, 5-500 |
Tablet |
Y42.3 |
| Glyburide |
1.5mg, 3mg, 6mg |
Tablet |
Y42.3 |
| Glyburide |
1.25mg, 2.5mg, 5mg |
Tablet |
Y42.3 |
| Glyburide/Metformin HCL |
1.25mg, 250mg, 2.5mg/500mg, 5mg/500mg |
Tablet |
Y42.3 |
| Insulin |
10ml/Vial |
Injection |
Y42.3 |
| Insulin Aspart |
10ml/Vial |
Injection |
Y42.3 |
| Insulin Detemir |
10ml/Vial |
Injection |
Y42.3 |
| Insulin glargine |
10ml/Vial |
Injection |
Y42.3 |
| Insulin Glulisine |
10ml, 3ml |
Injection |
Y42.3 |
| Insulin Lispro |
10ml/vial |
Injection |
Y42.3 |
| Linagliptin |
5mg |
Tablets |
Y42.3 |
| Linagliptin and Metformin Hydrochloride |
2.5mg/500mg, 2.5mg/850mg, 2.5mg/1000mg |
Tablets |
Y42.3 |
| Liraglutide [rDNA] Injection |
0.6mg, 1.2mg, or 1.8mg (6mg/mL, 3 mL). |
Injection |
Y42.3 |
| Metformin |
500mg, 850mg, 1000mg |
Tablet |
Y42.3 |
| Metformin, Extended-Release |
500mg, 750mg |
Tablet |
Y42.3 |
| Miglitol |
25mg, 50mg, 100mg |
Tablet |
Y42.3 |
| Nateglinide |
60mg, 120mg |
Tablet |
Y42.3 |
| One Touch Basic Test Strips |
|
Test Strips |
Y42.3 |
| One Touch FastTake Test Strips |
|
Test Strips |
Y42.3 |
| One Touch Profile Test Strips |
|
Test Strips |
Y42.3 |
| One Touch SureStep Test Strips |
|
Test Strips |
Y42.3 |
| One Touch Ultra Test Strips |
|
Test Strips |
Y42.3 |
| One Touch UltraSmart Test Strips |
|
Test Strips |
Y42.3 |
| Pioglitazone |
15mg, 30mg, 45mg |
Tablet |
Y42.3 |
| Pioglitazone and Metformin |
15mg/500mg |
Tablet |
Y42.3 |
| Repaglinide |
0.5mg, 1mg, 2mg |
Tablet |
Y42.3 |
| Repaglinide and Metformin |
1m/500mg, 2mg/500mg |
Tablet |
Y42.3 |
| Rosiglitazone |
2mg, 4mg, 8mg |
Tablet |
Y42.3 |
| Rosiglitazone and Metformin |
2mg/500mg, 4mg/1,000mg |
Tablets |
Y42.3 |
| Rosiglitazone/Metformin |
1-500, 2-500, 4-500 |
Tablet |
Y42.3 |
| Saxagliptin |
2.5mg, 5mg |
Tablets |
Y42.3 |
| Semaglutide |
0.25 mg, 0.5 mg, 1 mg |
Injection |
|
| Teneligliptin |
20 mg |
Tablet |
|
| Tolazamide |
100mg, 250mg, 500mg |
Tablet |
Y42.3 |
| Tolbutamide |
500mg |
Tablet |
Y42.3 |
| Vildagliptin |
|
|
Y42.3 |
| Vildagliptin |
50mg |
Tablet |
Y42.3 |
| Voglibose |
0.2mg, 0.3mg |
Tablets |
Y42.3 |
Diabetes
| Generic Name(s) |
Strength |
Dosage Form |
ICD Code |
| Human Insulin |
|
|
|
Diabetic peripheral neuropathy
| Generic Name(s) |
Strength |
Dosage Form |
ICD Code |
| Epalrestat |
50mg, 150mg |
Tablet |
|
SGLT2 inhibitors
| Generic Name(s) |
Strength |
Dosage Form |
ICD Code |
| Canagliflozin |
|
|
|