2009 Medicare Part D Plan Formulary Information |
Aetna Medicare Rx Premier (S5810-203-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Aetna Medicare Rx Premier. This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The Aetna Medicare Rx Premier (S5810-203-0) Formulary Drugs Starting with the Letter G in CMS PDP Region 33 which includes: HI
|
Drugs Starting with Letter G
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
GABAPENTIN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABAPENTIN 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABAPENTIN 400MG CAPSULE (10 CT) ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN 400MG CAPSULE (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:9 /1Days |
GABAPENTIN 400MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABAPENTIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABAPENTIN CAPSULES 300MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN CAPSULES 300MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABAPENTIN TABLET 800MG ![Compare how all Medicare Part D PDP plans in HI cover GABAPENTIN TABLET 800MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | Q:6 /1Days |
GABITRIL 12MG FILMTAB ![Compare how all Medicare Part D PDP plans in HI cover GABITRIL 12MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GABITRIL 16MG FILMTAB ![Compare how all Medicare Part D PDP plans in HI cover GABITRIL 16MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GABITRIL 2MG FILMTAB ![Compare how all Medicare Part D PDP plans in HI cover GABITRIL 2MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GABITRIL 4MG FILMTAB ![Compare how all Medicare Part D PDP plans in HI cover GABITRIL 4MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GALANTAMINE HBR 12MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HBR 12MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GALANTAMINE HBR 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HBR 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GALANTAMINE HBR 8MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HBR 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT ![Compare how all Medicare Part D PDP plans in HI cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GAMASTAN S/D INJECTION 16.5GM/2ML VIALGL ![Compare how all Medicare Part D PDP plans in HI cover GAMASTAN S/D INJECTION 16.5GM/2ML VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in HI cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in HI cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in HI cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in HI cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in HI cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GAMUNEX FOR SOLUTION 10GM/25ML VIALGL ![Compare how all Medicare Part D PDP plans in HI cover GAMUNEX FOR SOLUTION 10GM/25ML VIALGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GANCICLOVIR 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GANCICLOVIR 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
GANCICLOVIR 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GANCICLOVIR 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
GANTRISIN PED 500MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover GANTRISIN PED 500MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GARDASIL VIAL ![Compare how all Medicare Part D PDP plans in HI cover GARDASIL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | P |
GASTROCROM 100MG/5ML CONC ![Compare how all Medicare Part D PDP plans in HI cover GASTROCROM 100MG/5ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
GEMFIBROZIL TABLET 600MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover GEMFIBROZIL TABLET 600MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GEMZAR 1GRAM VIAL ![Compare how all Medicare Part D PDP plans in HI cover GEMZAR 1GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
GEMZAR 200MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover GEMZAR 200MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENERLAC SOLUTION 10G/15 ML 473 ML BOTPL ![Compare how all Medicare Part D PDP plans in HI cover GENERLAC SOLUTION 10G/15 ML 473 ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENGRAF 100MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in HI cover GENGRAF 100MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
GENGRAF 25MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in HI cover GENGRAF 25MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
GENOPTIC SOL 0.3% OP ![Compare how all Medicare Part D PDP plans in HI cover GENOPTIC SOL 0.3% OP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENOTROPIN 5.8MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN 5.8MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 0.2MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 0.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | P |
GENOTROPIN MINIQUICK 0.4MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 0.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 0.6MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 0.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 0.8MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 0.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 1.2MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 1.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENOTROPIN MINIQUICK 1.4MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 1.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 1.6MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 1.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 1.8MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 1.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 1MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN MINIQUICK 2MG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN MINIQUICK 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENOTROPIN POWDER FOR INJECTION 13.8MG 5 X 13.8MG CTG ![Compare how all Medicare Part D PDP plans in HI cover GENOTROPIN POWDER FOR INJECTION 13.8MG 5 X 13.8MG CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | P |
GENTAK 3MG/GM EYE OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAK 3MG/ML EYE DROPS ![Compare how all Medicare Part D PDP plans in HI cover GENTAK 3MG/ML EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN 100MG/NS 100ML ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 100MG/NS 100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 60MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 60MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENTAMICIN 60MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 60MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN 70MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 70MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN 80MG/NS 100ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 80MG/NS 100ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 80MG/NS 100ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 80MG/NS 100ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 80MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 80MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 80MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 80MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 90MG/NS 100ML PB ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN 90MG/NS 100ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN INJECTION PEDIATRIC 20MG 25 X 2ML VIALSD ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN INJECTION PEDIATRIC 20MG 25 X 2ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN INJECTION USP 40MG 25 X 20ML VIALMD ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN INJECTION USP 40MG 25 X 20ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN SULFATE 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENTAMICIN SULFATE IN NACL SOLUTION FOR INJECTION ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE IN NACL SOLUTION FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN SULFATE IN NACL SOLUTION FOR INJECTION 1 MG/ML ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE IN NACL SOLUTION FOR INJECTION 1 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in HI cover GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GENTASOL 3MG/ML EYE DROPS ![Compare how all Medicare Part D PDP plans in HI cover GENTASOL 3MG/ML EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GEODON 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GEODON 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
GEODON 20MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GEODON 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GEODON 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
GEODON 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GEODON 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
GEODON 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover GEODON 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S Q:2 /1Days |
GLEEVEC 100MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLEEVEC 100MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLEEVEC 400MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLEEVEC 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 - Specialty |
33% | 33% | None |
GLIMEPIRIDE 1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIMEPIRIDE 1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLIMEPIRIDE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIMEPIRIDE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLIMEPIRIDE 4MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIMEPIRIDE 4MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE AND METFORMIN HCL 2.5-250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE AND METFORMIN HCL 2.5-250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE AND METFORMIN HCL 5-500MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE AND METFORMIN HCL 5-500MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE ER 10MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE ER 10MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE ER 5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE ER 5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLIPIZIDE XL 10MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE XL 10MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE XL 2.5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE XL 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE XL 5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE XL 5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in HI cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in HI cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 - Preferred Brand |
$30.00 | $60.00 | None |
GLUCOPHAGE 1000MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOPHAGE 1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GLUCOPHAGE 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOPHAGE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GLUCOPHAGE 850MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOPHAGE 850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GLUCOPHAGE XR 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover GLUCOPHAGE XR 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
GLUCOPHAGE XR 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover GLUCOPHAGE XR 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUCOTROL 10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOTROL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOTROL 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOTROL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOTROL XL 10MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover GLUCOTROL XL 10MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOTROL XL 2.5MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover GLUCOTROL XL 2.5MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOTROL XL 5MG TABLET SA ![Compare how all Medicare Part D PDP plans in HI cover GLUCOTROL XL 5MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOVANCE 1.25/250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOVANCE 1.25/250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOVANCE 2.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOVANCE 2.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUCOVANCE 5/500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUCOVANCE 5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLUMETZA ER 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLUMETZA ER 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYBURIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYBURIDE AND METFORMIN HCL 1.25-250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE AND METFORMIN HCL 1.25-250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYBURIDE TABLET 1.25MG (50 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE TABLET 1.25MG (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYBURIDE TABLET MICRONIZED 6MG (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE TABLET MICRONIZED 6MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCOPYRROLATE 0.2MG/ML VL ![Compare how all Medicare Part D PDP plans in HI cover GLYCOPYRROLATE 0.2MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCRON 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYCRON 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYCRON 3MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYCRON 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYCRON 4.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYCRON 4.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYCRON 6MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYCRON 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GLYNASE 1.5MG PRESTAB ![Compare how all Medicare Part D PDP plans in HI cover GLYNASE 1.5MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYNASE PRESTAB TABLET 3MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYNASE PRESTAB TABLET 3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYNASE PRESTAB TABLET 6MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GLYNASE PRESTAB TABLET 6MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYSET 100MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYSET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYSET 25MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYSET 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GLYSET 50MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GLYSET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GOLYTELY PACKET 227.1 GM/2.82 GM ![Compare how all Medicare Part D PDP plans in HI cover GOLYTELY PACKET 227.1 GM/2.82 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM ![Compare how all Medicare Part D PDP plans in HI cover GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GRANISETRON HCL 0.1MG/ML VIAL INJECTION SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover GRANISETRON HCL 0.1MG/ML VIAL INJECTION SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
GRANISETRON HCL 1MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in HI cover GRANISETRON HCL 1MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P Q:2 /1Days |
GRANISETRON HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover GRANISETRON HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | P |
GRANISOL 1MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in HI cover GRANISOL 1MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | P Q:10 /1Days |
GRIFULVIN V 125MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in HI cover GRIFULVIN V 125MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GRIFULVIN V 500MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GRIFULVIN V 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GRIS-PEG 125MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GRIS-PEG 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GRIS-PEG 250MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GRIS-PEG 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GRISEOFULVIN 125MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in HI cover GRISEOFULVIN 125MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GUANABENZ ACETATE 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GUANABENZ ACETATE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GUANABENZ ACETATE 8MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GUANABENZ ACETATE 8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GUANFACINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GUANFACINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GUANFACINE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover GUANFACINE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 - Non-Preferred Generic |
$10.00 | $20.00 | None |
GUANIDINE HCL 125MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GUANIDINE HCL 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GYNAZOLE-1 CRE 2% ![Compare how all Medicare Part D PDP plans in HI cover GYNAZOLE-1 CRE 2%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 - Non-Preferred Brand |
$65.00 | $130.00 | None |
GYNODIOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GYNODIOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GYNODIOL 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GYNODIOL 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GYNODIOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GYNODIOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |
GYNODIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover GYNODIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 - Preferred Generic |
$0.00 | $0.00 | None |