Diabetes, Thiazolidinediones
PDL Reference Documents
Newsletters
- March 2016 - Antidiabetic Treatments and Cardiovascular Implications
- February 2016 - 2015 in Review: Relevant Safety Updates and Ongoing Safety Concerns
- October 2013 - Updates and Comparisons of Type 2 Diabetes Treatment Guidelines
- June 2012 - Can The Diabetic War Be Fought By Aggressive Blood Pressure Control?
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| NDC | Brand Name | Generic Name | Form | Strength | PDL Status |
Rebate | Current Drug Use Criteria |
|---|---|---|---|---|---|---|---|
| 64764015104 | ACTOS | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 00093727105 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 00093727156 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 00093727198 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 00904709061 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 16714064501 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 16714064502 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 16714064503 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 16729002015 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 16729002016 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 33342005407 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 33342005410 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 33342005415 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 57237021905 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 57237021930 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 57237021990 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 60687039101 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 60687039111 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 62135080430 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 65862051205 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 65862051230 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 65862051290 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 82009010305 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 15 mg | Y | Y | |
| 64764030114 | ACTOS | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 00093727205 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 00093727256 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 00093727298 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 00904709661 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 16714064601 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 16714064602 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 16714064603 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 16729002115 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 16729002116 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 33342005507 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 33342005510 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 33342005515 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 57237022005 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 57237022030 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 57237022090 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 62135080530 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 65862051305 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 65862051330 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 82009010405 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 30 mg | Y | Y | |
| 64764045124 | ACTOS | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 00093727305 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 00093727356 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 00093727398 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 16714064701 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 16714064702 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 16714064703 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 16729002215 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 16729002216 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 33342005607 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 33342005610 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 33342005615 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 57237022105 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 57237022130 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 57237022190 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 62135080630 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 65862051405 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 65862051430 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 65862051490 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 82009010505 | PIOGLITAZONE HCL | pioglitazone HCl | TABLET | 45 mg | Y | Y | |
| 64764030230 | DUETACT | pioglitazone HCl/glimepiride | TABLET | 30 mg-2 mg | N | Y | |
| 66993082130 | PIOGLITAZONE-GLIMEPIRIDE | pioglitazone HCl/glimepiride | TABLET | 30 mg-2 mg | N | Y | |
| 64764030430 | DUETACT | pioglitazone HCl/glimepiride | TABLET | 30 mg-4 mg | N | Y | |
| 66993082230 | PIOGLITAZONE-GLIMEPIRIDE | pioglitazone HCl/glimepiride | TABLET | 30 mg-4 mg | N | Y | |
| 33342017609 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-500 mg | N | Y | |
| 33342017657 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-500 mg | N | Y | |
| 57237021760 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-500 mg | N | Y | |
| 65862052518 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-500 mg | N | Y | |
| 65862052560 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-500 mg | N | Y | |
| 64764015860 | ACTOPLUS MET | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y | |
| 33342017709 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y | |
| 33342017757 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y | |
| 57237021860 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y | |
| 65862052618 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y | |
| 65862052660 | PIOGLITAZONE-METFORMIN | pioglitazone HCl/metformin HCl | TABLET | 15 mg-850 mg | N | Y |