Diabetes Drug Classes NCLEX® Review - Simple Nursing (2023)

It’s imperative to understand the many different types of diabetes medications as their function and adverse effects can lead to profound consequences for your clients. Hopefully, thisNCLEX® Review of Diabetic Drugswill serve as a good review of this subject – to aid your studying for your future practice.

Diabetes Drug Classes Practice Questions

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    Introduction to Diabetic Drugs

    In the year 2018, there was an estimated 34.2 million Americans (roughly 10.5% of the population) suffered from Type 2 Diabetes Mellitus (T2DM). An additional 1.6 million Americans suffer from Type 1 Diabetes Mellitus (T1DM). It goes without saying that the number of clients who present with diabetes is rapidly rising – leading to a variety of serious health complications including heart disease and hypertension.

    Fortunately, scientific advancements have dramatically improved the outcomes of clients suffering from T1DM as well as T2DM. Without the invention of insulin, T1DM clients and those with virtually no endogenous insulin production, would not be able to live for very long. Over the past few decades, oral and injectable therapies have been developed that enable T2DM clients to live independently of insulin for potentially a lifetime.

    Indications for Diabetic Drugs

    Diabetic drugs are only indicated for clients with advanced diabetes. This includes all clients with T1DM as their insulin production is null – as well as T2DM clients with chronically elevated blood sugar levels. However, one key exception to know is that metformin may be prescribed to clients with prediabetes, a condition where blood sugar levels are above normal but not so much to reach the diagnosis of T2DM.

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    Indications for Diabetes Drugs Table

    Type 1 Diabetes Mellitus (T1DM)
    • Clients with autoimmune destruction of pancreatic beta cells → absolute reduction in insulin production.
    Type 2 Diabetes Mellitus (T2DM)
    • Fasting Plasma Glucose>126 mg/dL
      • (Fasting defined as no caloric intake for at least 8 hours)
    • 2-h plasma glucose>200 mg/dL via oral glucose tolerance test (OGTT)
      • (Glucose load of 75g dissolved in water)
    • In clients with A1C>6.5%
    • A client with a random plasma glucose of>200
    • FPG 100 mg/dL to 125 mg/dL
    • 2-h PG during 75g OGTT
    • A1C 5.7%-6.4%

    Diabetes Medication Classes


    • MOA:
      • Regular
        • Onset: 30 minutes
        • Peak: 2-4 hours
        • Duration: 5-8 hours
      • Rapid Acting:
        • Onset: 3-15 minutes
        • Peak: 45-75 hours
        • Duration: 2-4 hours
      • Intermediate (NPH):
        • Onset: 2 hours
        • Peak: 4-12 hours
        • Duration: 8-18 hours
      • Long Acting:
        • Onset: 2 hours
        • Peak: 3-9 hours (insulin detemir only)
        • Duration: ~ 24 hours
      • Side Effects:
        • Hypoglycemia: Injecting too much insulin or insulin without carbohydrate intake can lead to hypoglycemia defined as blood glucose (BG) < 70 mg/dL. Signs and symptoms include shaking, irritability, loss of focus.
        • Weight gain
        • Injection site reactions
      • Precautions
        • Avoid sliding scale insulin as this can increase the risk of hypoglycemia
        • Taking insulin with other diabetic medications (e.g. sulfonylureas) may increase the risk of hypoglycemia
      • Nursing Considering:
        • Injection technique for new insulin users:
          • Insulin can be injected into the abdominal wall, leg, arm, or buttock.
          • When changing from one site to another the speed of absorption of insulin may be different (e.g. the abdominal to the leg) clients should avoid changing the general site of injection and alternate on that spot. (e.g. rotating injection site on the abdomen)
          • It is recommended that clients alternate the site of injection to avoid scarring and adverse effects.
          • The pens need to be primed before use to ensure proper insulin dosage is administered.
          • When injecting insulin prior to meals it is imperative that the client remembers to eat to avoid hypoglycemia.
        • Hypoglycemia Management:
          • Signs and symptoms include shaking, irritability, loss of focus.
          • Generally, clients with hypoglycemia (BG < 70) can be managed by taking either glucose tablets or by eating and drinking carbs (1 serving of juice, candy, fruit)
          • The goal is to consume 15 grams of carbs every 15 minutes until resolution of hypoglycemia (> 70 mg/dL)
          • Clients who are comatose or not alert may require an administration of glucagon (more common for T1DM) to raise blood sugars
          • Severe hypoglycemia may warrant a hospital visit
    • Common Key Generics (Brand):
      • Regular:
        • Humulin (R)
        • Novolin (R)
      • Rapid-Acting:
        • Lispro (Humalog)
        • Aspart (Novolog)
        • Glulisine (Apidra)
      • Intermediate (NPH)
        • Humulin (N)
        • Novolin (N)
      • Long acting
        • Insulin glargine (Basaglar, Lantus, Toujeo)
        • Insulin detemir (Levemir)
        • Insulin degludec (Tresiba)


    • MOA:
      • Decreases hepatic glucose production
      • Decreases intestinal absorption of glucose
      • Improves insulin sensitivity
    • Side Effects:
      • GI Upset
        • Diarrhea
        • Nausea
        • Vomiting
      • Weight gain/loss
      • Lactic acidosis
    • Precautions:
      • Black box warning: Risk of lactic acidosis resulting in death. Risk factors include renal impairment, concomitant use of certain drugs (e.g. topiramate),>65 years old, excess alcohol intake.
    • Nursing Considering:
      • This is the preferred 1stline treatment for clients with T2DM
      • Clients may need to be titrated up on this medication to mitigate adverse effects
      • Avoid in chronic kidney disease (eGFR < 45)
    • Common Key Generics (Brand)
      • Metformin (Glucophage)

    GLP-1 Receptor Agonists:

    • MOA:
      • Mimics glucagon-like peptide 1 (GLP-1) hormone
      • Binds to GLP-1 receptors stimulating glucose-dependent insulin release
      • Delays gastric emptying – increasing satiation
    • Side Effects:
      • Weight loss
      • Increased satiation (fullness)
      • Acute pancreatitis
      • Injection site reactions
    • Precautions
      • Avoid in clients with pancreatitis
    • Nursing Considering:
      • This may be considered prior to starting clients on insulin in order to reduce A1c when oral diabetic medications are inadequate.
      • These medications are associated with cardiovascular benefits – clients with cardiovascular disease may be good candidates for these medications.
      • Some of these medications may be unsafe in clients with severe renal disease
      • Clients with potential adherence issues should avoid GLP-1 agonists that require daily administration (e.g. liraglutide, exenatide)
      • Currently most of these medications are administered via subcutaneous injection (Rybelsus) was a recently approved oral formulation.
    • Common Key Generics (Brands)
      • Liraglutide (Saxenda)
      • Exenatide (Byetta)
      • Dulaglutide (Victoza)
      • Semaglutide (Ozempic, Rybelsus)

    DPP-4 Inhibitors:

    • MOA:
      • Prevents DPP-4 enzymes from breaking down the GLP-1 hormone
    • Side Effects:
      • Weight neutral
      • Acute pancreatitis
      • Hepatic dysfunction
      • Serious skin reactions (vildagliptin, saxagliptin)
    • Nursing Considering
      • These medications should be used with caution in clients with renal disease.
    • Common Key Generics (Brands)
      • Saxagliptin (Onglyza)
      • Sitagliptin (Januvia)
      • Linagliptin (Trajenta)


    • MOA:
      • Stimulates insulin release in pancreatic beta cells
    • Side Effects:
      • Hypoglycemia: These medications stimulate the release of insulin regardless of glucose intake. Taking alongside insulin dramatically increases hypoglycemic risk.
      • Weight gain
      • Sulfa allergies
      • Photosensitivity
    • Precautions:
      • Sulfa moiety contained in these compounds – avoid these medications in clients with sulfa allergies
      • Increased risk of hypoglycemia in clients with chronic kidney disease
    • Nursing Considering:
      • Hypoglycemia is less common with glipizide
      • Use with caution in clients on insulin
      • Use with caution in clients with “sulfa allergies”
      • Use with caution in clients with severe renal disease
      • Common Key Generics (Brands)
      • Glyburide (Glynase)
      • Glipizide (Glucotrol)
      • Glimepiride (Amaryl)


    • MOA:
      • Increase insulin sensitivity by acting on adipose tissue
      • Increases musculoskeletal glucose utilization
      • Decreases glucose production in the liver
    • Side Effects:
      • Weight gain
      • Fluid retention – heart failure exacerbation
      • Macular edema
    • Precautions:
      • Increased risk of myocardial infarction and cardiovascular death – avoid in heart failure clients.
    • Nursing Considering:
      • Avoid these medications in heart failure
      • These medications do cause weight gain
    • Common Key Generics (Brands)
      • Pioglitazone (Actos)
      • Rosiglitazone (Avandia)

    SGLT2 Inhibitors:

    • MOA:
      • Inhibits SGLT2 to reduce the reabsorption of glucose by up to 90% – promoting the excretion of glucose from the body.
    • Side Effects:
      • Weight loss
      • Hypotension
      • Acute kidney injury
      • Increased risk of bone fracture
      • Diabetic ketoacidosis
    • Precautions
      • Avoid in clients with increased risk of fractures (e.g. osteoporosis)
      • Avoid in clients who are prone to diabetic ketoacidosis
      • Avoid in clients who have frequent urinary tract infections
    • Nursing Considering:
      • These medications are associated with cardiovascular benefits – making candidates with advanced cardiovascular disease a good candidate for these medications.
      • These medications increase the risk of urinary tract infections (primarily yeast infections)
      • Avoid in clients with poor kidney function
    • Common Key Generics (Brands)
      • Canagliflozin (Invokana)
      • Dapagliflozin (Farxiga)
      • Empagliflozin (Jardiance)

    Diabetes Drug Classes NCLEX® Review - Simple Nursing (2)

    Amy Stricklen

    Diabetes Drug Classes NCLEX® Review - Simple Nursing (3)

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    Diabetes Drug Classes NCLEX® Review - Simple Nursing (4)

    Amy Stricklen

    Key Nursing Tips for Diabetic Drugs

    • Insulin is always indicated in clients with T1DM and tends to be a treatment for progressed T2DM where oral medications or GLP-1 injections are inadequate for A1C reduction.
    • Clients with T1DM are primarily treated with insulin – oral diabetic medications are ineffective as their pancreatic insulin production is null.
    • Insulin and sulfonylureas both increase the risk of hypoglycemia – which can be severe and may potentially lead to death.
    • Metformin is often the first-line treatment for clients with T2DM and is a potential treatment for clients with prediabetes.
    • Many diabetes medications need to be used with caution in clients with advanced renal disease.
    • GLP-1 agonists may sometimes be used instead of insulin as a first-line injectable therapy for clients with T2DM
    • Many diabetes medications can increase weight gain – consider medications associated with weight loss properties in obese and overweight clients (e.g. GLP-1 agonists, SGLT2 inhibitors).

    Diabetic Drug Classes Conclusion

    Diabetes is a complex and chronic disease that affects millions of Americans every day. Diabetes increases the risk of having cardiovascular diseases including hypotension, heart disease, and for having CV events (e.g. MI, stroke). There are many key considerations to keep in mind when treating clients with diabetes as there are many kinds of medications with various side effect profiles.

    It’s important to have a firm understanding of diabetes medications as their prevalence is rapidly increasing every year for Americans today. Hopefully thisNCLEX® Review of Diabetic Drugsaids in the study of diabetes and in your practice down the line.


    1. Statistics About Diabetes. Statistics About Diabetes | ADA. https://www.diabetes.org/resources/statistics/statistics-about-diabetes. Accessed April 21, 2020.
    2. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. https://care.diabetesjournals.org/content/43/Supplement_1/S14.figures-only. Published January 1, 2020. Accessed April 21, 2020.
    3. American Diabetes Association. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2020. Diabetes Care. https://care.diabetesjournals.org/content/43/Supplement_1/S98. Published January 1, 2020. Accessed April 21, 2020.
    4. Weinstock, RS. General principles of insulin therapy in diabetes mellitus. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.
    5. Metformin: Drug Information. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.
    6. Dungan K, DeSantis A. Glucagon-like peptide 1 receptor agonists for the treatment of type 2 diabetes mellitus. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.
    7. Dungan K, DeSantis A. Dipeptidyl peptidase 4 (DPP-4) inhibitors for the treatment of type 2 diabetes mellitus. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.
    8. Wexler D. Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.
    9. Inzucchi S, Lupsa B. Thiazolidinediones in the treatment of type 2 diabetes mellitus. In: Post T, ed.UpToDate. Waltham, MA.: UpToDate; 2020. www.uptodate.com. Accessed April 21st, 2020.

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    Diabetes Drug Classes NCLEX® Review - Simple Nursing (11)


    What are the classes of drugs for diabetes? ›

    Currently, there are ten classes of orally available pharmacological agents to treat T2DM: 1) sulfonylureas, 2) meglitinides, 3) metformin (a biguanide), 4) thiazolidinediones (TZDs), 5) alpha glucosidase inhibitors, 6) dipeptidyl peptidase IV (DPP-4) inhibitors, 7) bile acid sequestrants, 8) dopamine agonists, 9) ...

    How do you memorize different insulins? ›

    Mnemonic For The Different Types of Insulin
    1. The “N” in iNsulin is for Novolog.
    2. The “L” in insuLin is for HumAlog.
    3. All rapid-acting insulin analogs end with the postfix “log.”

    What are the classes of metformin? ›

    Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver.

    What class of drug is metformin? ›

    Metformin is an oral anti-diabetic drug in the biguanide class for the treatment of type 2 diabetes mellitus, in particular, in overweight and obese people and those with normal kidney function.

    How to remember all the drug names? ›

    Here are four tips for how you can memorize drugs for pharmacology.
    1. Pace your memorization. So, you have come here to unlock the secrets of how to memorize pharmacology fast and furiously! ...
    2. Start with drug classes before specific medications. ...
    3. Spice up your study approach. ...
    4. Try Picmonic for efficient, quick drug memorization.
    Jan 20, 2023

    What is the mnemonic for diabetes? ›

    The mnemonic “GLUCOSE BAD” assists the practitioner in remembering the necessary guidelines in managing diabetic patients.

    How can I memorize medication easily? ›

    6 Tips for Pharmacists to Memorize New Drugs Quickly
    1. Memorize no more than one per day. ...
    2. Repeat what you memorized. ...
    3. Memorize new drugs in order of class. ...
    4. Memorize new drugs with acronyms. ...
    5. Memorize new drugs with picture association. ...
    6. Memorize new drugs with a memory palace (advanced technique)
    May 10, 2017

    What is the easiest class in nursing school? ›

    The Easiest Classes in Nursing School
    • Social Sciences (Intro Psychology, Sociology, etc.)
    • Humanities.
    • Intro to Speech (or Communication)
    • English Composition.
    • History.
    • Using Information Technology.

    What is the hardest class in nursing school? ›

    Hardest Nursing School Classes
    • Pathophysiology. In this course, students learn how different anatomical systems work and how diseases or injuries affect these systems. ...
    • Pharmacology. ...
    • Medical Surgical 1 (also known as Adult Health 1) ...
    • Evidence-Based Practice.

    Do you mix NPH or regular insulin first? ›

    When you mix regular insulin with another type of insulin, always draw the regular insulin into the syringe first. When you mix two types of insulins other than regular insulin, it does not matter in what order you draw them into the syringe.

    Do you draw up cloudy or clear insulin first? ›

    If clear and cloudy insulin are used, it is only possible to remove bubbles from the clear insulin, which is drawn up first. Draw up cloudy insulin slowly and carefully to avoid forming bubbles. Remove the needle from the insulin bottle. If cloudy insulin is also needed, it must first be mixed.

    What 2 insulins can be mixed with NPH? ›

    Mixing Insulin
    • NPH can be mixed with Humalog, Novolog, and Regular (R) insulin.
    • Long-acting insulins (Lantus, Toujeo, Levemir, Tresiba) and Apidra (short acting) CANNOT be mixed with any other insulin.
    Jul 1, 2022

    What class is metoprolol? ›

    Metoprolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure.

    What drug class is glipizide? ›

    Glipizide is in a class of medications called sulfonylureas. Glipizide lowers blood sugar by causing the pancreas to produce insulin (a natural substance that is needed to break down sugar in the body) and helping the body use insulin efficiently.

    What drug class is amlodipine? ›

    Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart.

    What class of drugs is omeprazole? ›

    Omeprazole is in a class of medications called proton-pump inhibitors. It works by decreasing the amount of acid made in the stomach.

    What class of drug is atorvastatin? ›

    Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

    What is gabapentin used for? ›

    About gabapentin Brand name: Neurontin

    Gabapentin is used to treat epilepsy. It's also taken for nerve pain, which can be caused by different conditions, including diabetes and shingles. Nerve pain can also happen after an injury.

    What do the 4 letters after a drug name mean? ›

    Have you ever wondered what is behind the seemingly random letter strings attached to the nonproprietary names (also known as “proper names”) of these biosimilars? The short answer is that they are used to distinguish a biosimilar product from the original biologic product.

    What are the 3 ways drugs are named? ›

    There are three main types of names used for pharmaceutical substances: the chemical name, the International Nonproprietary Name (INN) also known as the approved or generic name, and the proprietary or brand name.

    What are the 9 memory robbing drugs? ›

    Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote) and zonisamide (Zonegran).

    What are the 4 P's of diabetes? ›

    The bottom line. The three P's of diabetes are polydipsia, polyuria, and polyphagia. These terms correspond to increases in thirst, urination, and appetite, respectively. The three P's often — but not always — occur together.

    What are the five S's diabetes? ›

    Sitting (or not), stepping, sweating, strengthening and sleeping – the five S's approach to managing Type 2 Diabetes.

    What are the 7 A's diabetes? ›

    The original model included: 'Ask', 'Assess', 'Advise', 'Assist' and 'Arrange'. The Australian originator's additions to the model have also been adopted. These are, 'be Aware' and 'Assign' and reflect the need for vigilance about emotional distress and the potential need for referrals to specialists.

    What is the best drug for memorization? ›

    Prescription smart drugs, such as Adderall and Ritalin, have the strongest and most significant effects on memory and attention. Synthetic nootropic supplements like Noopept and piracetam are widely available, but research on their effectiveness in healthy adults is lacking.

    What is the second most important right thing to remember in passing meds? ›

    2. Right Drug. Make sure you are giving them the correct drug that is on their chart and prescription.

    What is the fastest way to administer a drug? ›

    Intravenous administration is the best way to deliver a precise dose quickly and in a well-controlled manner throughout the body. It is also used for irritating solutions, which would cause pain and damage tissues if given by subcutaneous or intramuscular injection.

    Which state is the hardest to become a nurse? ›

    • MAINE. ...
    • ALASKA. ...
    • Georgia. ...
    • Alabama. ...
    • Hawaii. ...
    • South Carolina. ...
    • Kentucky. ...
    • Summary. There are a few cases when temporary licenses can be obtained through the state board of nursing.

    What is the hardest semester of nursing school? ›

    Without question, the most difficult semester for me was the last semester of my junior year in nursing school. I attended a 4-year BSN program, and that particular semester included three classes that were very content-heavy, as well as the corresponding clinical hours for those classes.

    What is the hardest part of the NCLEX? ›

    Let's look at the 16 most common challenges NCLEX candidates face and ways you can overcome them.
    1. Second-Guessing Your Abilities. ...
    2. Changing Answers Repeatedly. ...
    3. Reading Questions Too Fast. ...
    4. Cramming Before the Test. ...
    5. Not Using the Right Study Tools. ...
    6. Not Getting Enough Rest Before the Test. ...
    7. Reading Too Much into a Question.

    Is simple nursing good for NCLEX? ›

    Together, Simple Nursing and Picmonic have helped thousands of students through school on their way to becoming successful healthcare professionals. Simple Nursing breaks down subjects to help me understand them and it is also good for NCLEX tips.

    Do I need to know all meds for NCLEX? ›

    Is there a 'need to know' list of drugs for the NCLEX? NCSBN does not specify a list of medications that are on the exam.

    What is the dropout rate for nursing students? ›

    According to the National League for Nursing, the national dropout rate for nursing programs in the United States is 20%, and this high attrition rate is considered problematic.

    Is it common to fail a class in nursing school? ›

    Many nursing schools require a minimum grade of roughly 80% to actually pass, as well. By the time you realize you aren't doing well enough to be successful in the course, the choices can be pretty limited. Failure happens all the time.

    What percent of nursing students fail a class? ›

    Nursing school is difficult and will be hard to pass. Most students pass their nursing program, so you can too. How many nursing students fail? According to the National League of Nursing, the dropout rate for nursing programs in the United States is around 20%.

    What are the three main classifications of insulin medications? ›

    short-acting insulin. intermediate-acting insulin. mixed insulin. long-acting insulin.

    What are Tier 2 drugs for type 2 diabetes? ›

    Tier 2 includes the drug classes of thiazolidinediones and GLP-1 receptor agonists. Other drugs that are not included in the algorithm but may benefit certain individuals include DPP-4 inhibitors, meglitinides, alpha-glucosidase inhibitors, colesevelam, and bromocriptine.

    What are the 3 classes of insulin duration? ›

    Terms To Know
    Insulin TypeOnsetDuration
    Regular/short acting30 minutes3 to 6 hours
    Intermediate acting2 to 4 hours12 to 18 hours
    Long acting2 hoursUp to 24 hours
    Ultra-long acting6 hours36 hours or longer
    3 more rows

    What are the 4 types of insulin? ›

    The types of insulin include:
    • Rapid-acting, which starts to work within a few minutes and lasts a couple of hours.
    • Regular- or short-acting, which takes about 30 minutes to work fully and lasts 3 to 6 hours.
    • Intermediate-acting, which takes 2 to 4 hours to work fully. ...
    • Long-acting, which can work for an entire day.
    Aug 25, 2022

    What is the classification of Humalog and NovoLog? ›

    Humalog and Novolog are rapid-acting insulins.

    What are Tier 1 2 and 3 drugs? ›

    Level or Tier 1: Low-cost generic and brand-name drugs. Level or Tier 2: Higher-cost generic and brand-name drugs. Level or Tier 3: High-cost, mostly brand-name drugs that may have generic or brand-name alternatives in Levels 1 or 2. Level or Tier 4: Highest-cost, mostly brand-name drugs.

    What is Tier 1 vs Tier 2 vs Tier 3 drugs? ›

    Tier 1: Least expensive drug options, often generic drugs. Tier 2: Higher price generic and lower-price brand-name drugs. Tier 3: Mainly higher price brand-name drugs.

    Is Jardiance a Tier 3 drug? ›

    Medicare prescription drug plans typically list Jardiance on Tier 3 of their formulary. Generally, the higher the tier, the more you have to pay for the medication.


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