MedicarePartD.guide

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2026 Blue Rx PDP Plus (PDP) formulary (drug list)

Contract S5593, plan 002 · West Virginia · 3,788 drugs on file · formulary ID 00026017. Each drug links to its cost in every CMS PDP Region 06 plan.

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101 drugs starting with G.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
GABAPENTIN 100 mg Capsule2Generic25%25%
  • QL 27 per 30 days
GABAPENTIN 250 mg/5mL Solution3Preferred Brand25%25%
  • QL 216 per 30 days
GABAPENTIN 300 mg Capsule2Generic25%25%
  • QL 36 per 30 days
GABAPENTIN 400 mg Capsule2Generic25%25%
  • QL 27 per 30 days
GABAPENTIN 600 mg Tablet2Generic25%25%
  • QL 18 per 30 days
GABAPENTIN 800 mg Tablet2Generic25%25%
  • QL 12 per 30 days
GALANTAMINE 12 mg Tablet, Film Coated2Generic25%25%None
GALANTAMINE 16 mg Capsule, Extended Release3Preferred Brand25%25%None
GALANTAMINE 24 mg Capsule, Extended Release3Preferred Brand25%25%None
GALANTAMINE 4 mg Tablet, Film Coated2Generic25%25%None
GALANTAMINE 8 mg Capsule, Extended Release3Preferred Brand25%25%None
GALANTAMINE 8 mg Tablet, Film Coated2Generic25%25%None
GALANTAMINE HYDROBROMIDE 4 mg/mL Solution4Non-Preferred Drug25%25%None
GALLIFREY 5 mg TabletNorethindrone Acetate2Generic25%25%None
GAMMAGARD LIQUID 100 mg/mL Injection, SolutionImmune Globulin Infusion (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD LIQUID 100 mg/mL Injection, SolutionImmune Globulin Infusion (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD LIQUID 100 mg/mL Injection, SolutionImmune Globulin Infusion (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD LIQUID ERC 100 mg/mL Injection, SolutionImmune Globulin Infusion (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD LIQUID ERC 100 mg/mL Injection, SolutionImmune Globulin Infusion (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD S/D KitImmune Globulin Intravenous (Human)5Specialty Tier25%25%
  • PA
GAMMAGARD S/D KitImmune Globulin Intravenous (Human)5Specialty Tier25%25%
  • PA
GARDASIL 9 30/40/60/40/20/20/20/20/20 ug/.5mL Injection, SuspensionHuman Papillomavirus 9-Valent Vaccine, Recombinant3Preferred Brand25%25%None
GARDASIL 9 30/40/60/40/20/20/20/20/20 ug/.5mL Injection, SuspensionHuman Papillomavirus 9-Valent Vaccine, Recombinant3Preferred Brand25%25%None
GATIFLOXACIN 5 mg/mL Solution3Preferred Brand25%25%None
GATTEX KitTeduglutide5Specialty Tier25%25%
  • PA
GAVILYTE - C TM 240/5.84/2.98/6.72/22.72 g/278.26g Powder, For SolutionPolyethylene Glycol-3350 And Electrolytes With Flavor Pack1Preferred Generic25%25%None
GAVILYTE G TM 236/22.74/6.74/5.86/2.97 g/274.31g Powder, For SolutionPolyethylene Glycol-3350 And Electrolytes1Preferred Generic25%25%None
GAVILYTE-N 420/11.2/5.72/1.48 g/438.4g Powder, For SolutionPolyethylene Glycol-3350, Sodium Chloride, Potassium Chloride And Sodium Bicarbonate1Preferred Generic25%25%None
GAVRETO 100 mg CapsulePralsetinib5Specialty Tier25%25%
  • PA
  • QL 124 per 31 days
GEFITINIB 250 mg Tablet, Coated5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GEMFIBROZIL 600 mg Tablet1Preferred Generic25%25%None
GEMTESA 75 mg Tablet, Film CoatedVibegron4Non-Preferred Drug25%25%
  • QL 31 per 31 days
GENERLAC 10 g/15mL SolutionLactulose2Generic25%25%None
GENGRAF 100 mg CapsuleCyclosporine2Generic25%25%
  • PA
GENGRAF 25 mg CapsuleCyclosporine2Generic25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin4Non-Preferred Drug25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENOTROPIN KitSomatropin5Specialty Tier25%25%
  • PA
GENTAMICIN SULFATE 1 mg/g Cream2Generic25%25%
  • QL 6 per 28 days
GENTAMICIN SULFATE 1 mg/g Ointment2Generic25%25%
  • QL 6 per 28 days
GENTAMICIN SULFATE 3 mg/mL Solution1Preferred Generic25%25%None
GENTAMICIN SULFATE 40 mg/mL Injection, Solution1Preferred Generic25%25%None
GENTAMICIN SULFATE IN SODIUM CHLORIDE 100 mg/100mL Injection, SolutionGentamicin Sulfate2Generic25%25%None
GENTAMICIN SULFATE IN SODIUM CHLORIDE 60 mg/50mL Injection, SolutionGentamicin Sulfate2Generic25%25%None
GENTAMICIN SULFATE IN SODIUM CHLORIDE 80 mg/100mL Injection, SolutionGentamicin Sulfate2Generic25%25%None
GENTAMICIN SULFATE IN SODIUM CHLORIDE 80 mg/50mL Injection, SolutionGentamicin Sulfate2Generic25%25%None
GENVOYA 150/150/200/10 mg TabletElvitegravir, Cobicistat, Emtricitabine, And Tenofovir Alafenamide5Specialty Tier25%25%None
GILOTRIF 20 mg Tablet, Film CoatedAfatinib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GILOTRIF 30 mg Tablet, Film CoatedAfatinib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GILOTRIF 40 mg Tablet, Film CoatedAfatinib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GLASSIA 1 g/50mL Injection, SolutionAlpha.1-Proteinase Inhibitor Human5Specialty Tier25%25%
  • PA
GLATIRAMER ACETATE 20 mg/mL Injection, Solution5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GLATIRAMER ACETATE 40 mg/mL Injection, SolutionGlatiramer5Specialty Tier25%25%
  • PA
  • QL 12 per 28 days
GLATOPA 20 mg/mL Injection, SolutionGlatiramer Acetate5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
GLATOPA 40 mg/mL Injection, SolutionGlatiramer Acetate5Specialty Tier25%25%
  • PA
  • QL 12 per 28 days
GLIMEPIRIDE 1 mg Tablet1Preferred Generic25%25%None
GLIMEPIRIDE 2 mg Tablet1Preferred Generic25%25%None
GLIMEPIRIDE 4 mg Tablet1Preferred Generic25%25%None
GLIPIZIDE 10 mg Tablet1Preferred Generic25%25%None
GLIPIZIDE 10 mg Tablet, Film Coated, Extended Release1Preferred Generic25%25%None
GLIPIZIDE 2.5 mg Tablet, Film Coated, Extended Release1Preferred Generic25%25%None
GLIPIZIDE 5 mg Tablet1Preferred Generic25%25%None
GLIPIZIDE 5 mg Tablet, Film Coated, Extended Release1Preferred Generic25%25%None
GLIPIZIDE AND METFORMIN HYDROCHLORIDE 2.5/250 mg Tablet, Film Coated1Preferred Generic25%25%None
GLIPIZIDE AND METFORMIN HYDROCHLORIDE 2.5/500 mg Tablet, Film Coated1Preferred Generic25%25%None
GLIPIZIDE AND METFORMIN HYDROCHLORIDE 5/500 mg Tablet, Film Coated1Preferred Generic25%25%None
GLUCAGON Kit3Preferred Brand25%25%None
GLYBURIDE 1.25 mg Tablet2Generic25%25%None
GLYBURIDE 2.5 mg Tablet2Generic25%25%None
GLYBURIDE 5 mg Tablet2Generic25%25%None
GLYBURIDE AND METFORMIN HYDROCHLORIDE 1.25/250 mg Tablet, Film Coated2Generic25%25%None
GLYBURIDE AND METFORMIN HYDROCHLORIDE 2.5/500 mg Tablet, Film Coated2Generic25%25%None
GLYBURIDE AND METFORMIN HYDROCHLORIDE 5/500 mg Tablet, Film Coated2Generic25%25%None
GLYCEROL PHENYLBUTYRATE 1.1 g/mL LiquidGlycerol Phenylbutyrate Oral5Specialty Tier25%25%
  • PA
GLYCOPYRROLATE 1 mg Tablet2Generic25%25%None
GLYCOPYRROLATE 2 mg Tablet2Generic25%25%None
GLYXAMBI 10/5 mg Tablet, Film CoatedEmpagliflozin And Linagliptin3Preferred Brand25%25%
  • QL 31 per 31 days
GLYXAMBI 25/5 mg Tablet, Film CoatedEmpagliflozin And Linagliptin3Preferred Brand25%25%
  • QL 31 per 31 days
GOMEKLI 1 mg CapsuleMirdametinib5Specialty Tier25%25%
  • PA
  • QL 126 per 28 days
GOMEKLI 1 mg Tablet, For SuspensionMirdametinib5Specialty Tier25%25%
  • PA
  • QL 168 per 28 days
GOMEKLI 2 mg CapsuleMirdametinib5Specialty Tier25%25%
  • PA
  • QL 84 per 28 days
GRANISETRON HYDROCHLORIDE 1 mg Tablet4Non-Preferred Drug25%25%
  • PA
GRISEOFULVIN 500 mg Tablet4Non-Preferred Drug25%25%None
GRISOFULVIN 125 mg/5mL Suspension2Generic25%25%None
GUANFACINE EXTENDED-RELEASE 1 mg Tablet, Extended ReleaseGuanfacine2Generic25%25%
  • PA
GUANFACINE EXTENDED-RELEASE 2 mg Tablet, Extended ReleaseGuanfacine2Generic25%25%
  • PA
GUANFACINE EXTENDED-RELEASE 3 mg Tablet, Extended ReleaseGuanfacine2Generic25%25%
  • PA
GUANFACINE EXTENDED-RELEASE 4 mg Tablet, Extended ReleaseGuanfacine2Generic25%25%
  • PA
GVOKE HYPOPEN 0.5 MG AUTO-INJECTOR .5 mg/.1mL Injection, SolutionGlucagon Injection, Solution3Preferred Brand25%25%None
GVOKE HYPOPEN 1 MG AUTO-INJECTOR 1 mg/.2mL Injection, SolutionGlucagon Injection, Solution3Preferred Brand25%25%None
GVOKE KIT 1 mg/.2mL Injection, SolutionGlucagon Injection, Solution3Preferred Brand25%25%None
GVOKE PFS 1 MG PRE-FILLED SYRINGE 1 mg/.2mL Injection, SolutionGlucagon Injection, Solution3Preferred Brand25%25%None

PA = prior authorization, ST = step therapy, QL = quantity limit. Costs are the plan’s initial-coverage cost-sharing from the CMS 2026 formulary files; a drug not listed here is not on this plan’s formulary, though a formulary exception may still be possible.