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2017 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:

Drug Names Containing the Letter G in Alphabetical Order.
Example: Lipitor® is found on letter page "L" as well as letter page "A" for Atorvastatin.

Drug Name
Packaging NDC On This Nbr of 2017 Formularies
PDPs MAPDs
AMARYL 1MG TABLET
(Glimepiride)
100 BOT 00039022110 6
PDPs
11
MAPDs
AMARYL 2MG TABLET
(Glimepiride)
100 BOT 00039022210 6
PDPs
11
MAPDs
AMARYL 4MG TABLET
(Glimepiride)
100 BOT 00039022310 6
PDPs
11
MAPDs
BEVESPI AEROSPHERE INHALER
(Glycopyrrolate and formoterol fumarate)
10.700 GM   00310460012 23
PDPs
89
MAPDs
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN
(Glatiramer Acetate)
    68546031730 45
PDPs
231
MAPDs
COPAXONE 40 MG/ML SYRINGE
(Glatiramer Acetate)
1 ML   68546032512 57
PDPs
307
MAPDs
CUVPOSA 1 MG/5 ML SOLUTION
(Glycopyrrolate)
    00259050116 11
PDPs
70
MAPDs
CYTOVENE IV INJECTION
(Ganciclovir Sodium For)
10ML X 1 X 25 VIALS CRTN 00004694003 5
PDPs
16
MAPDs
GABAPENTIN 100mg/1
(Gabapentin)
    62756013702 59
PDPs
341
MAPDs
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE
(Gabapentin)
470 mL in 1 BOTTLE   50383031147 59
PDPs
341
MAPDs
GABAPENTIN CAPSULES 300MG
(Gabapentin)
    60505011301 59
PDPs
341
MAPDs
GABAPENTIN 400 MG CAPSULE
(Gabapentin)
100 EA   53746010301 59
PDPs
341
MAPDs
GABAPENTIN 600MG TABLET
(Gabapentin)
100 BOT 00228263611 59
PDPs
341
MAPDs
GABAPENTIN TABLET 800MG
(Gabapentin)
    60505255205 59
PDPs
341
MAPDs
GABITRIL 12 MG TABLET
(Tiagabine HCl)
30 EA   63459041230 44
PDPs
313
MAPDs
GABITRIL 16mg/1
(Tiagabine HCl)
    63459041630 44
PDPs
314
MAPDs
GABITRIL 2mg/1
(Tiagabine HCl)
    63459040230 5
PDPs
22
MAPDs
GABITRIL 4mg/1
(Tiagabine HCl)
    63459040430 5
PDPs
22
MAPDs
Gablofen 2000ug/mL 20 mL in 1 VIAL, GLASS
(Baclofen)
20 mL in 1 VIAL, GLASS   45945015702 10
PDPs
44
MAPDs
Gablofen 50ug/mL 1 mL in 1 SYRINGE, PLASTIC
(Baclofen)
1 mL in 1 SYRINGE, PLASTI   45945015101 10
PDPs
44
MAPDs
Gablofen 500ug/mL 20 mL in 1 VIAL, GLASS
(Baclofen)
20 mL in 1 VIAL, GLASS   45945015502 10
PDPs
44
MAPDs
Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE
(Galantamine Hydrobromide)
60 TABLET, FILM COATED in   00555014009 55
PDPs
325
MAPDs
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT
(Galantamine Hydrobromide)
30 BOT 00555102101 55
PDPs
325
MAPDs
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT
(Galantamine Hydrobromide)
30 BOT 00555102201 55
PDPs
325
MAPDs
Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE
(Galantamine Hydrobromide)
100 mL in 1 BOTTLE   00054013749 55
PDPs
317
MAPDs
Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE
(Galantamine Hydrobromide)
60 TABLET, FILM COATED in   00555013809 55
PDPs
325
MAPDs
GALANTAMINE ER 8 MG CAPSULE
(Galantamine Hydrobromide)
30 EA   00378810593 55
PDPs
325
MAPDs
Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE
(Galantamine Hydrobromide)
60 TABLET, FILM COATED in   00555013909 55
PDPs
325
MAPDs
GamaSTAN S/D 0.165g/mL
(Immune Globulin (Human))
    13533063512 42
PDPs
261
MAPDs
GAMASTAN S-D 10 ML
(Immune Globulin (Human))
    13533063513 36
PDPs
240
MAPDs
GAMASTAN S-D 2 ML
(Immune Globulin (Human))
    13533063540 36
PDPs
240
MAPDs
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS
(Immune Globulin (Human) IV)
1 BOTTLE, GLASS in 1 CART   00944270003 33
PDPs
270
MAPDs
GAMMAGARD S-D 10 G (IGA<1) SOL
(Immune Globulin (Human) IV)
    00944265804 33
PDPs
241
MAPDs
GAMMAGARD S-D 5 G (IGA<1) SOLN
(Immune Globulin (Human) IV)
    00944265603 33
PDPs
241
MAPDs
GAMMAKED 1 GRAM/10 ML VIAL
(Immune Globulin)
10 ML   76125090001 30
PDPs
197
MAPDs
GAMMAPLEX 10 GRAM/100 ML VIAL
(immune globulin)
    64208823506 40
PDPs
241
MAPDs
GAMMAPLEX 20 GRAM/200 ML VIAL
(immune globulin)
    64208823503 40
PDPs
241
MAPDs
GAMMAPLEX INJECTION 5 GM/100 ML
(Immune Globulin)
    64208823403 44
PDPs
253
MAPDs
GAMMAPLEX 5 GRAM/50 ML VIAL
(immune globulin)
    64208823505 42
PDPs
246
MAPDs
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS
(Immune Globulin (Human) IV)
10 mL in 1 VIAL, GLASS   13533080012 44
PDPs
292
MAPDs
GANCICLOVIR 500MG VIAL FOR INJECTION
(Ganciclovir)
25 X 10 TRAY 63323031510 59
PDPs
341
MAPDs
GARDASIL 9 VIAL
(Quadrivalent Human Papillomavirus (HPV) Recombinant Vac)
    00006411903 59
PDPs
341
MAPDs
GARDASIL 9 SYRINGE
(Quadrivalent Human Papillomavirus (HPV) Recombinant Vac)
    00006412102 59
PDPs
341
MAPDs
GASTROCROM 100 MG/5 ML CONC
(Cromolyn Sodium Oral)
    00037067896 1
PDPs
10
MAPDs
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid]
(gatifloxacin ophthalmic)
2.5 ML   68180043501 26
PDPs
257
MAPDs
GATTEX 5 MG ONE-VIAL KIT
(teduglutide)
    68875010301 59
PDPs
337
MAPDs
GAVILYTE-H AND BISACODYL KIT
(BISAC/NACL/NAHCO3/KCL/PEG 3350)
1 EA   43386007183 38
PDPs
160
MAPDs
GAVILYTE-G SOLUTION
(Polyethylene Glycol 3350 Oral)
274.31 g in 1 BOTTLE   43386009019 59
PDPs
319
MAPDs
GAVILYTE-C SOLUTION
(Polyethylene Glycol 3350 Oral)
278.26 g in 1 BOTTLE   43386006019 59
PDPs
327
MAPDs
GAVILYTE-N SOLUTION
(Polyethylene Glycol 3350 Oral)
438.4 g in 1 BOTTLE   43386005019 59
PDPs
327
MAPDs
GELNIQUE 100mg/g 30 PACKET per CARTON / 1 g in 1 PACKET
(Oxybutynin Chloride)
30 PACKET in 1 CARTON / 1   52544008430 5
PDPs
54
MAPDs
Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL
()
1 VIAL in 1 CARTON / 25 m   16729011711 50
PDPs
298
MAPDs
GEMFIBROZIL TABLET 600MG (500 CT)
(Gemfibrozil)
500 BOT 00143913005 59
PDPs
341
MAPDs
GEMZAR 1GRAM VIAL
(Gemcitabine HCl For)
1 X 50 ML VIAL 00002750201 1
PDPs
14
MAPDs
GENERESS FE CHEWABLE TABLET
(norethindrone and ethinyl estradiol and ferrous fumarate)
28 EA   52544020431 1
PDPs
14
MAPDs
GENERLAC 10 GM/15 ML SOLUTION
(Lactulose (Encephalopathy))
1892 ML   60432003864 59
PDPs
329
MAPDs
GENGRAF 100 MG CAPSULE
(Cyclosporine Modified)
30 EA   00074310932 59
PDPs
328
MAPDs
GENGRAF 100MG/ML SOLUTION
(Cyclosporine Modified)
50 ML BOTGL 00074726950 59
PDPs
326
MAPDs
GENGRAF 25 MG CAPSULE
(Cyclosporine Modified)
30 EA   00074310832 59
PDPs
328
MAPDs
GENGRAF 50 MG CAPSULE
(Cyclosporine Modified)
    00074054130 59
PDPs
330
MAPDs
GENOTROPIN 13.8MG CARTRIDGE
(Somatropin For)
1 X 13.8 MG CTG 00013264681 18
PDPs
151
MAPDs
GENOTROPIN 5 MG CARTRIDGE
(Somatropin For)
1 PKGCOM 00013262681 18
PDPs
149
MAPDs
GENOTROPIN MINIQUICK 0.2MG
(Somatropin For)
7 X 0.2 MG VIALPAT 00013264902 18
PDPs
152
MAPDs
GENOTROPIN MINIQUICK 0.4MG
(Somatropin For)
7 X 0.4 MG VIALPAT 00013265002 18
PDPs
150
MAPDs
GENOTROPIN MINIQUICK 0.6MG
(Somatropin For)
7 X 0.6 MG VIALPAT 00013265102 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 0.8MG
(Somatropin For)
7 X 0.8 MG VIALPAT 00013265202 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 1MG
(Somatropin For)
7 X 1.0 MG VIALPAT 00013265302 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 1.2MG
(Somatropin For)
7 VIALPAT 00013265402 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 1.4MG
(Somatropin For)
7 VIALPAT 00013265502 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 1.6MG
(Somatropin For)
7 VIALPAT 00013265602 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 1.8MG
(Somatropin For)
7 VIALPAT 00013265702 18
PDPs
148
MAPDs
GENOTROPIN MINIQUICK 2MG
(Somatropin For)
7 X 2.0 MG VIALPAT 00013265802 18
PDPs
148
MAPDs
GENTAK 3MG/GM EYE OINTMENT
(Gentamicin Sulfate Ophth)
3.5 GM TUBE 17478028435 59
PDPs
314
MAPDs
Gentamicin 10 mg/ml vial
(Gentamicin)
    00409340201 57
PDPs
317
MAPDs
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE
(Gentamicin Sulfate)
15 GM TUBE 45802004635 59
PDPs
336
MAPDs
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE
(Gentamicin Sulfate)
15 GM TUBE 45802005635 59
PDPs
338
MAPDs
Gentamicin Sulfate 40mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE
(Gentamicin Sulfate)
25 VIAL, SINGLE-DOSE in 1   00409120703 59
PDPs
326
MAPDs
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG
(Gentamicin Sulfate)
50 mL in 1 BAG   00338050741 53
PDPs
282
MAPDs
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT
(Gentamicin Sulfate Ophth)
5 ML BOT 24208058060 59
PDPs
335
MAPDs
GENVOYA TABLET
(Elvitegravir, Cobicistat, Emtricitabine, and Tenofovir Alafenamide Fumarate)
    61958190101 59
PDPs
340
MAPDs
GEODON 20MG VIAL
(Ziprasidone HCl)
1 VIAL VIALSD 00049392083 59
PDPs
341
MAPDs
GEODON 20MG CAPSULE
(Ziprasidone HCl)
60 BOT 00049396060 4
PDPs
10
MAPDs
GEODON 40MG CAPSULE
(Ziprasidone HCl)
60 BOT 00049397060 4
PDPs
10
MAPDs
GEODON 60MG CAPSULE
(Ziprasidone HCl)
60 BOT 00049398060 4
PDPs
10
MAPDs
GEODON 80MG CAPSULE
(Ziprasidone HCl)
60 BOT 00049399060 4
PDPs
10
MAPDs
Gianvi 3 mg-0.02 mg tablet
(Drospirenone-Ethinyl Estradiol)
    00093542328 47
PDPs
271
MAPDs
GIAZO 180 GM
(balsalazide disodium)
    65649010202 2
PDPs
35
MAPDs
gildagia 0.4 mg-0.035 mg tab
(ethinyl estradiol / norethindrone)
    00603359017 54
PDPs
289
MAPDs
GILENYA 0.5 MG CAPSULE
(FINGOLIMOD HCL)
30 EA   00078060715 47
PDPs
313
MAPDs
GILOTRIF 20 MG TABLET
(afatinib)
30 EA   00597014130 59
PDPs
341
MAPDs
GILOTRIF 30 MG TABLET
(afatinib)
30 EA   00597013730 59
PDPs
341
MAPDs
GILOTRIF 40 MG TABLET
(afatinib)
30 EA   00597013830 59
PDPs
341
MAPDs
GLASSIA 1g/50mL 1 VIAL, GLASS per CARTON / 50 mL in 1 VIAL, GLASS
(ALPHA-1-PROTEINASE INHIBITOR (HUMAN))
1 VIAL, GLASS in 1 CARTON   00944288401 11
PDPs
142
MAPDs
Glatopa 20 mg/ml syringe
(Glatiramer Acetate)
    00781323434 45
PDPs
218
MAPDs
GLEEVEC 100MG TABLET (90 CT)
(Imatinib Mesylate)
90 BOT 00078040134 12
PDPs
114
MAPDs
GLEEVEC 400 MG TABLET
(Imatinib Mesylate)
30 EA   00078064930 12
PDPs
114
MAPDs
GLEOSTINE 10 MG CAPSULE
(Lomustine)
    58181304005 56
PDPs
320
MAPDs
GLEOSTINE 100 MG CAPSULE
(Lomustine)
    58181304205 56
PDPs
320
MAPDs
GLEOSTINE 40 MG CAPSULE
(Lomustine)
    58181304105 56
PDPs
320
MAPDs
GLEOSTINE 5 MG CAPSULE
(Lomustine)
    58181304305 59
PDPs
340
MAPDs
GLIMEPIRIDE 1MG TABLET (100 CT)
(Glimepiride)
100 BOT 55111032001 59
PDPs
341
MAPDs
GLIMEPIRIDE 2MG TABLET (100 CT)
(Glimepiride)
100 BOT 55111032101 59
PDPs
341
MAPDs
GLIMEPIRIDE 4MG TABLET (100 CT)
(Glimepiride)
100 BOT 55111032201 59
PDPs
341
MAPDs
GLIPIZIDE 10MG TABLET (100 CT)
(Glipizide)
100 BOT 00378111001 59
PDPs
341
MAPDs
GLIPIZIDE 10MG TABLETS EXTENDED RELEASE
(Glipizide)
100 BOT 00591084501 59
PDPs
340
MAPDs
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR
(Glipizide)
30 BOTPL 00591090030 59
PDPs
340
MAPDs
GLIPIZIDE-METFORMIN 2.5-500MG TABLET
(Glipizide)
100 BOT 00093745601 57
PDPs
334
MAPDs
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE
(Glipizide)
100 BOT 00591084401 59
PDPs
340
MAPDs
Glipizide 5mg/1 500 TABLET BOTTLE
(Glipizide)
500 TABLET in 1 BOTTLE   16729013916 59
PDPs
341
MAPDs
GLIPIZIDE-METFORMIN 5-500 MG
(Glipizide)
100 EA   00093745701 57
PDPs
334
MAPDs
Glipizide and Metformin Hydrochloride 2.5; 250mg/1; mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC /
(Glipizide-Metformin HCl)
100 BOTTLE, PLASTIC in 1   00378313101 57
PDPs
334
MAPDs
GLUCAGEN 1MG HYPOKIT
(Glucagon HCl (rDNA) For)
1 X 1 MG PKGCOM 00169706515 59
PDPs
327
MAPDs
GLUCAGON 1MG EMERGENCY KIT
(Glucagon (rDNA) For)
1 KIT PKGCOM 00002803101 55
PDPs
336
MAPDs
GLUCOPHAGE 1000MG TABLET
(Metformin HCl)
100 BOT 00087607111 6
PDPs
11
MAPDs
GLUCOPHAGE 500MG TABLET
(Metformin HCl)
500 BOT 00087606010 6
PDPs
11
MAPDs
GLUCOPHAGE 850MG TABLET
(Metformin HCl)
100 BOT 00087607005 6
PDPs
11
MAPDs
GLUCOPHAGE XR 500MG TABLET SA
(Metformin HCl)
100 BOT 00087606313 6
PDPs
11
MAPDs
GLUCOPHAGE XR 750MG TABLET SA
(Metformin HCl)
100 BOT 00087606413 6
PDPs
11
MAPDs
GLUCOTROL 10MG TABLET
(Glipizide)
100 BOT 00049412066 7
PDPs
13
MAPDs
GLUCOTROL 5MG TABLET
(Glipizide)
100 BOT 00049411066 7
PDPs
13
MAPDs
GLUCOTROL XL 10 MG TABLET
(Glipizide)
500 EA   00049017808 6
PDPs
11
MAPDs
GLUCOTROL XL 2.5 MG TABLET
(Glipizide)
30 EA 00049017001 6
PDPs
11
MAPDs
GLUCOTROL XL 5 MG TABLET
(Glipizide)
    00049017403 6
PDPs
11
MAPDs
GLUCOVANCE 2.5/500MG TABLET
(Glyburide-Metformin)
100 BOT 00087607311 2
PDPs
7
MAPDs
GLUCOVANCE 5/500MG TABLET
(Glyburide-Metformin)
100 BOT 00087607411 2
PDPs
7
MAPDs
GLUMETZA ER 1,000 MG TABLET
(Metformin HCl)
    68012000316 2
PDPs
23
MAPDs
GLUMETZA ER 500 MG TABLET
(Metformin HCl)
    68012000213 3
PDPs
24
MAPDs
GLYBURIDE 1.25MG TABLETS
(Glyburide)
100 TABLETS BOT 00093834201 20
PDPs
165
MAPDs
GLYBURIDE 2.5MG TABLET (100 CT)
(Glyburide)
100 TABLETS BOT 00093834301 20
PDPs
165
MAPDs
GLYBURIDE 5MG TABLETS
(Glyburide)
500 TABLETS BOT 00093834405 20
PDPs
165
MAPDs
Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC
(Glyburide)
500 TABLET BOTTLE   00143992005 20
PDPs
161
MAPDs
GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT)
(Glyburide Micronized)
100 BOT 00378111301 20
PDPs
161
MAPDs
GLYBURIDE MICRO 3MG TABLET (100 CT)
(Glyburide Micronized)
100 TABLETS BOT 00093803501 20
PDPs
162
MAPDs
Glyburide 1.25 MG / Metformin hydrochloride 250 MG Oral Tablet [Glucovance]
(Glyburide-Metformin)
    55111069501 20
PDPs
148
MAPDs
GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET [Glucovance]
(Glyburide-Metformin)
500 BOT 00228275250 20
PDPs
148
MAPDs
GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET [Glucovance]
(Glyburide-Metformin)
500 BOT 00228275350 20
PDPs
148
MAPDs
GLYCOPYRROLATE 0.2MG/ML VL
(Glycopyrrolate)
25 X 20 ML VIALMD 00517462025 42
PDPs
250
MAPDs
GLYCOPYRROLATE TABLET 1MG (100 CT)
(Glycopyrrolate)
100 BOT 49884006501 51
PDPs
328
MAPDs
GLYCOPYRROLATE TABLET 2MG (100 CT)
(Glycopyrrolate)
100 BOT 49884006601 51
PDPs
326
MAPDs
GLYNASE 1.5MG PRESTAB
(Glyburide Micronized)
100 BOT 00009034101 0
PDPs
5
MAPDs
Glynase 3mg/1 1000 TABLET BOTTLE, PLASTIC
(Glyburide Micronized)
1000 TABLET in 1 BOTTLE,   00009035204 0
PDPs
5
MAPDs
GLYNASE 6 MG PRESTAB
(Glyburide Micronized)
100 EA   00009344901 0
PDPs
5
MAPDs
GLYSET 100MG TABLET
(Miglitol)
100 BOTPL 00009501401 6
PDPs
78
MAPDs
GLYSET 25MG TABLET
(Miglitol)
100 BOT 00009501201 6
PDPs
78
MAPDs
GLYSET 50MG TABLET
(Miglitol)
100 BOTPL 00009501301 6
PDPs
78
MAPDs
GLYXAMBI 10 MG-5 MG TABLET
(Empagliflozin and Linagliptin)
    00597018230 8
PDPs
113
MAPDs
GLYXAMBI 25 MG-5 MG TABLET
(Empagliflozin and Linagliptin)
    00597016430 8
PDPs
113
MAPDs
GOLYTELY PACKET 227.1 GM/2.82 GM
(PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For)
263 GM PKT 52268070001 28
PDPs
124
MAPDs
GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM
(PEG 3350-KCl-Na Bicarb-NaCl-Na Sulfate For)
4 L BOT 52268010001 24
PDPs
90
MAPDs
GONITRO 0.4 MG SUBLINGUAL PWD
(Nitroglycerin)
1.000 EA   70007040001 3
PDPs
22
MAPDs
Gralise Starter Pack 1 KIT per BLISTER PACK
(Gabapentin)
1 KIT in 1 BLISTER PACK   13913000616 7
PDPs
77
MAPDs
GRALISE ER 300 MG TABLET
(Gabapentin)
    13913000419 7
PDPs
77
MAPDs
Gralise 600 MG 90 FILM COATED TABLETS in BOTTLE
(Gabapentin)
90 TABLET, FILM COATED in   13913000519 7
PDPs
77
MAPDs
Granisetron HCl 0.1 mg/ml vial
(Granisetron HCl)
    63323031701 46
PDPs
279
MAPDs
Granisetron hcl 1 mg/ml vial
(Granisetron HCl)
    17478054602 46
PDPs
273
MAPDs
Granisetron hcl 1 mg/ml vial
(Granisetron HCl)
    63323031904 46
PDPs
242
MAPDs
Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE
(Granisetron HCl)
2 TABLET in 1 BOTTLE   00054014387 57
PDPs
318
MAPDs
GRANIX 300 MCG/0.5 ML SYRINGE
(tbo-filgrastim)
    63459091011 35
PDPs
246
MAPDs
GRANIX 480 MCG/0.8 ML SYRINGE
(tbo-filgrastim)
    63459091211 35
PDPs
246
MAPDs
GRASTEK 2;800 BAU SL TABLET
(timothy grass pollen allergen extract)
    00006422930 17
PDPs
92
MAPDs
GRIS-PEG 125MG TABLET
(Griseofulvin Ultramicrosize)
100 BOT 00884076304 4
PDPs
15
MAPDs
GRIS-PEG 250 MG TABLET
(Griseofulvin Ultramicrosize)
100 EA   00884077304 6
PDPs
17
MAPDs
GRISEOFULVIN 125 MG/5 ML SUSP
(Griseofulvin Microsize)
120 ML   00472001304 54
PDPs
314
MAPDs
griseofulvin micro 500 mg tab
(Griseofulvin Microsize)
    64980018601 41
PDPs
283
MAPDs
griseofulvin ultra 125 mg tab
(Griseofulvin Ultra)
    64980018401 54
PDPs
284
MAPDs
griseofulvin ultra 250 mg tab
(Griseofulvin Ultra)
    64980018501 54
PDPs
284
MAPDs
Guanfacine hcl er 1 mg tablet
(Guanfacine HCl)
    00228285011 36
PDPs
242
MAPDs
GUANFACINE 1MG TABLET
(Guanfacine HCl)
100 BOT 00591044401 23
PDPs
165
MAPDs
Guanfacine hcl er 2 mg tablet
(Guanfacine HCl)
    00228285111 36
PDPs
242
MAPDs
GUANFACINE 2MG TABLET (100 CT)
(Guanfacine HCl)
100 BOT 00378119001 23
PDPs
165
MAPDs
Guanfacine hcl er 3 mg tablet
(Guanfacine HCl)
    00228285311 36
PDPs
242
MAPDs
Guanfacine hcl er 4 mg tablet
(Guanfacine HCl)
    00228285511 36
PDPs
242
MAPDs
guanidine hcl 125 mg tablet
(Guanidine HCl)
    00085049201 43
PDPs
280
MAPDs
GYNAZOLE-1 2% CREAM
(Butoconazole Nitrate (One Dose) Vaginal)
5 GM   45802039601 4
PDPs
47
MAPDs
HORIZANT ER 300 MG TABLET
(GABAPENTIN ENACARBIL)
    53451010301 3
PDPs
56
MAPDs
HORIZANT ER 600 MG TABLET
(GABAPENTIN ENACARBIL)
    53451010101 3
PDPs
55
MAPDs
IMATINIB MESYLATE 100 MG TABLET [Gleevec]
(Imatinib Mesylate)
90 EA   47335047281 56
PDPs
301
MAPDs
IMATINIB MESYLATE 400 MG TABLET [Gleevec]
(Imatinib Mesylate)
30 EA   47335047583 56
PDPs
301
MAPDs
IRESSA 250 MG TABLET
(Gefitinib)
30 EA   00310048230 59
PDPs
341
MAPDs
ISOTONIC GENTAMICIN 100 MG/100 ML
(Gentamicin in Saline)
100 ML   00338050548 53
PDPs
295
MAPDs
ISOTON GENTAMICIN 80MG/100ML
(Gentamicin in Saline)
100 ML BAG 00338050348 53
PDPs
279
MAPDs
ISOTONIC GENTAMICIN 80 MG/50 ML
(Gentamicin in Saline)
50 ML   00338050941 53
PDPs
289
MAPDs
LOPID 600 MG TABLET
(Gemfibrozil)
60 EA   00071073720 6
PDPs
11
MAPDs
Miglitol 100 MG TABLET [Glyset]
(Miglitol)
    57664068688 18
PDPs
209
MAPDs
Miglitol 25 MG TABLET [Glyset]
(Miglitol)
    57664068488 18
PDPs
209
MAPDs
Miglitol 50 MG TABLET [Glyset]
(Miglitol)
    57664068588 18
PDPs
209
MAPDs
NAGLAZYME 5MG/5ML VIAL
(Galsulfase)
5ML VIALSU 68135002001 59
PDPs
341
MAPDs
NEOMYCIN/POLYMY/GRAM EYE DROPS 0.025MG/ML 1.75MG/M
(Neomycin-Polymyxin B-Gramicidin Ophth)
10 ML BOT 24208079062 59
PDPs
329
MAPDs
NEURONTIN 100MG CAPSULE
(Gabapentin)
100 BOT 00071080324 5
PDPs
14
MAPDs
NEURONTIN 250MG/5ML TUBEX
(Gabapentin)
470 ML BOT 00071201223 5
PDPs
15
MAPDs
NEURONTIN 300MG CAPSULE
(Gabapentin)
100 BOT 00071080524 5
PDPs
14
MAPDs
NEURONTIN 400MG CAPSULE
(Gabapentin)
100 BOT 00071080624 5
PDPs
14
MAPDs
NEURONTIN 600MG TABLET
(Gabapentin)
100 BOT 00071051324 5
PDPs
14
MAPDs
NEURONTIN 800MG TABLET
(Gabapentin)
100 BOT 00071040124 5
PDPs
14
MAPDs
NutreStore 5g/1 84 PACKET in 1 BOX / 1 POWDER, FOR SOLUTION in 1 PACKET
(Glutamine)
84 PACKET in 1 BOX / 1 PO   42457000184 4
PDPs
40
MAPDs
ORALAIR 300 IR SUBLINGUAL TAB
(Grass Pollen Allergen Extract)
30 EA   59617001502 13
PDPs
64
MAPDs
POLYETH GLYC NF POWDER FOR ORAL SOLUTION 17GM (527 CT)
(Polyethylene Glycol 3350 Powder)
527 BOT 00574041205 59
PDPs
341
MAPDs
PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR
(Gentamicin-Prednisolone Ace Ophth)
5 ML BOTDR 00023010605 18
PDPs
129
MAPDs
PRED-G S.O.P. EYE OINTMENT
(Gentamicin-Prednisolone Ace Ophth)
3.5 GM TUBE 00023006604 18
PDPs
114
MAPDs
RAVICTI 1.1 GRAM/ML LIQUID
(Glycerol Phenylbutyrate)
25 ML   75987005006 44
PDPs
292
MAPDs
RAZADYNE 12MG TABLET
(Galantamine Hydrobromide)
TABLETS BOT 50458039860 4
PDPs
9
MAPDs
RAZADYNE 4MG TABLET
(Galantamine Hydrobromide)
60 TABLETS BOT 50458039660 6
PDPs
11
MAPDs
RAZADYNE 8MG TABLET
(Galantamine Hydrobromide)
60 TABLETS BOT 50458039760 4
PDPs
9
MAPDs
RAZADYNE ER 16MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT 50458038830 4
PDPs
9
MAPDs
RAZADYNE ER 24MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT 50458038930 4
PDPs
9
MAPDs
RAZADYNE ER 8MG CAPSULE
(Galantamine Hydrobromide)
30 CAPSULES BOT 50458038730 4
PDPs
9
MAPDs
ROBINUL 0.4 MG/2 ML VIAL
(Glycopyrrolate)
    00641610525 1
PDPs
15
MAPDs
ROBINUL 1MG TABLET
(Glycopyrrolate)
100 TABS BOTPL 59630020010 4
PDPs
9
MAPDs
ROBINUL FORTE 2MG TABLET
(Glycopyrrolate)
100 TABS BOTPL 59630020510 4
PDPs
15
MAPDs
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN
(Granisetron Transdermal)
1 PATCH CRTN 42747072601 12
PDPs
118
MAPDs
SIMPONI 100 MG/ML SYRINGE
(Golimumab Subcutaneous)
1 ML   57894007101 15
PDPs
181
MAPDs
SIMPONI 100 MG/ML PEN INJECTOR
(Golimumab Subcutaneous)
1 ML   57894007102 15
PDPs
169
MAPDs
SIMPONI 50 MG/0.5 ML PEN INJEC
(Golimumab Subcutaneous)
0.5 ML   57894007002 12
PDPs
152
MAPDs
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR
(Golimumab Subcutaneous)
1 50 MG SINGLE DOSE SYR SYR 57894007001 12
PDPs
167
MAPDs
SIMPONI ARIA 50 MG/4 ML VIAL
(golimumab)
4 ML   57894035001 6
PDPs
147
MAPDs
tiagabine hcl 2 mg tablet [Gabitril]
(Tiagabine HCl)
    62756020083 59
PDPs
340
MAPDs
tiagabine hcl 4 mg tablet [Gabitril]
(Tiagabine HCl)
    62756022483 59
PDPs
340
MAPDs
ZIPRASIDONE HCL 20 MG CAPSULE [Geodon]
(Ziprasidone HCl)
    68180033107 59
PDPs
341
MAPDs
ZIPRASIDONE HCL 40 MG CAPSULE [Geodon]
(Ziprasidone HCl)
    68180033207 59
PDPs
341
MAPDs
ZIPRASIDONE HCL 60 MG CAPSULE [Geodon]
(Ziprasidone HCl)
    55111025860 59
PDPs
341
MAPDs
ZIPRASIDONE HCL 80 MG CAPSULE [Geodon]
(Ziprasidone HCl)
    00904627208 59
PDPs
341
MAPDs
ZIRGAN 1.5mg/g 1 TUBE, WITH APPLICATOR per CARTON / 5 g in 1 TUBE, WITH APPLICATOR
(Ganciclovir Ophth)
1 TUBE, WITH APPLICATOR i   24208053535 49
PDPs
314
MAPDs
ZYMAXID 5mg/mL 1 BOTTLE, DROPPER per CARTON / 2.5 mL in 1 BOTTLE, DROPPER
(Gatifloxacin Ophth)
1 BOTTLE, DROPPER in 1 CA   00023361525 1
PDPs
9
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data )


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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.