2013 Medicare Part D Plan Formulary Information |
Health Net Healthy Heart (PPO) (H5520-010-0)
Benefit Details
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The Health Net Healthy Heart (PPO) (H5520-010-0) Formulary Drugs Starting with the Letter G in JOSEPHINE County, OR: CMS MA Region 23 which includes: OR
|
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/1 ![Compare how all Medicare Part D PDP plans in OR cover GABAPENTIN 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Gabapentin 250mg/5mL 470 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GABAPENTIN 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover GABAPENTIN 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GABAPENTIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GABAPENTIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GABAPENTIN CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in OR cover GABAPENTIN CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GABAPENTIN TABLET 800MG ![Compare how all Medicare Part D PDP plans in OR cover GABAPENTIN TABLET 800MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GABITRIL 12 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GABITRIL 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GABITRIL 16mg/1 ![Compare how all Medicare Part D PDP plans in OR cover GABITRIL 16mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GABITRIL 2mg/1 ![Compare how all Medicare Part D PDP plans in OR cover GABITRIL 2mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GABITRIL 4mg/1 ![Compare how all Medicare Part D PDP plans in OR cover GABITRIL 4mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 OR cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 OR cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 OR cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GamaSTAN S/D 0.165g/mL ![Compare how all Medicare Part D PDP plans in OR cover GamaSTAN S/D 0.165g/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | P |
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS in 1 CARTON / 25 mL in 1 BOTTLE, GLASS ![Compare how all Medicare Part D PDP plans in OR cover GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS in 1 CARTON / 25 mL in 1 BOTTLE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
GAMMAPLEX INJECTION 5 GM/100 ML ![Compare how all Medicare Part D PDP plans in OR cover GAMMAPLEX INJECTION 5 GM/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in OR cover Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GANCICLOVIR FOR INJECTION ![Compare how all Medicare Part D PDP plans in OR cover GANCICLOVIR FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GARDASIL VIAL ![Compare how all Medicare Part D PDP plans in OR cover GARDASIL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GaviLyte - C TM 240; 2.98; 6.72; 5.84; 22.72g/278.26g; g/278.26g; g/278.26g; g/278.26g; g/278.26g 27 ![Compare how all Medicare Part D PDP plans in OR cover GaviLyte - C TM 240; 2.98; 6.72; 5.84; 22.72g/278.26g; g/278.26g; g/278.26g; g/278.26g; g/278.26g 27.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GaviLyte - N 420; 1.48; 5.72; 11.2g/438.4g; g/438.4g; g/438.4g; g/438.4g 438.4 g in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover GaviLyte - N 420; 1.48; 5.72; 11.2g/438.4g; g/438.4g; g/438.4g; g/438.4g 438.4 g in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GaviLyte G TM 236; 2.97; 6.74; 5.86; 22.74g/274.31g; g/274.31g; g/274.31g; g/274.31g; g/274.31g 274. ![Compare how all Medicare Part D PDP plans in OR cover GaviLyte G TM 236; 2.97; 6.74; 5.86; 22.74g/274.31g; g/274.31g; g/274.31g; g/274.31g; g/274.31g 274..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GELNIQUE 100mg/g 30 PACKET in 1 CARTON / 1 g in 1 PACKET ![Compare how all Medicare Part D PDP plans in OR cover GELNIQUE 100mg/g 30 PACKET in 1 CARTON / 1 g in 1 PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GELNIQUE 3% GEL ![Compare how all Medicare Part D PDP plans in OR cover GELNIQUE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Gemcitabine Hydrochloride 1g/25mL 1 VIAL in 1 CARTON / 25 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in OR cover Gemcitabine Hydrochloride 1g/25mL 1 VIAL in 1 CARTON / 25 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GEMFIBROZIL TABLET 600MG (500 CT) ![Compare how all Medicare Part D PDP plans in OR cover GEMFIBROZIL TABLET 600MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | None |
GEMZAR 1GRAM VIAL ![Compare how all Medicare Part D PDP plans in OR cover GEMZAR 1GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GENERESS FE CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in OR cover GENERESS FE CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENERLAC 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover GENERLAC 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GENGRAF 100MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in OR cover GENGRAF 100MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
GENGRAF 25MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in OR cover GENGRAF 25MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
GENOTROPIN 13.8MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN 13.8MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN 5 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN 5 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 0.2MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 0.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GENOTROPIN MINIQUICK 0.4MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 0.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 0.6MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 0.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 0.8MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 0.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 1.2MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 1.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
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 OR cover GENOTROPIN MINIQUICK 1.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 1.6MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 1.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 1.8MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 1.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 1MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENOTROPIN MINIQUICK 2MG ![Compare how all Medicare Part D PDP plans in OR cover GENOTROPIN MINIQUICK 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GENTAK 3MG/GM EYE OINTMENT ![Compare how all Medicare Part D PDP plans in OR cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 100MG/NS 100ML ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN 100MG/NS 100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN 80MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN 80MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Gentamicin Sulfate 40mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in OR cover Gentamicin Sulfate 40mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 OR cover GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in OR cover Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | None |
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GEODON 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover GEODON 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GEODON 20MG VIAL ![Compare how all Medicare Part D PDP plans in OR cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GEODON 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover GEODON 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GEODON 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover GEODON 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GEODON 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover GEODON 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in OR cover Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
gildagia 0.4 mg-0.035 mg tab ![Compare how all Medicare Part D PDP plans in OR cover gildagia 0.4 mg-0.035 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Gilenya 0.5mg/1 28 CAPSULE in 1 CARTON ![Compare how all Medicare Part D PDP plans in OR cover Gilenya 0.5mg/1 28 CAPSULE in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLASSIA 1g/50mL 1 VIAL, GLASS in 1 CARTON / 50 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in OR cover GLASSIA 1g/50mL 1 VIAL, GLASS in 1 CARTON / 50 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLEEVEC 100MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLEEVEC 100MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GLEEVEC 400MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLEEVEC 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
GLIMEPIRIDE 1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLIMEPIRIDE 1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:2 /1Days |
GLIMEPIRIDE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLIMEPIRIDE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:2 /1Days |
GLIMEPIRIDE 4MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLIMEPIRIDE 4MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:2 /1Days |
GLIPIZIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | None |
GLIPIZIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | Q:4 /1Days |
Glipizide and Metformin Hydrochloride 2.5; 250mg/1; mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC / ![Compare how all Medicare Part D PDP plans in OR cover Glipizide and Metformin Hydrochloride 2.5; 250mg/1; mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC /.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Glipizide and Metformin Hydrochloride 5; 500mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Glipizide and Metformin Hydrochloride 5; 500mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 OR cover GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLIPIZIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLIPIZIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | Q:2 /1Days |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in OR cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $70.00 | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in OR cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLUCOPHAGE 1000MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOPHAGE 1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOPHAGE 500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOPHAGE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOPHAGE 850MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOPHAGE 850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOPHAGE XR 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover GLUCOPHAGE XR 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOPHAGE XR 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover GLUCOPHAGE XR 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOTROL 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOTROL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUCOTROL 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOTROL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:4 /1Days |
GLUCOTROL XL 10MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover GLUCOTROL XL 10MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUCOTROL XL 2.5MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover GLUCOTROL XL 2.5MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:2 /1Days |
GLUCOTROL XL 5MG TABLET SA ![Compare how all Medicare Part D PDP plans in OR cover GLUCOTROL XL 5MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:2 /1Days |
GLUCOVANCE 2.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOVANCE 2.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | P |
GLUCOVANCE 5/500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUCOVANCE 5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | P |
GLUMETZA ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUMETZA ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLUMETZA ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLUMETZA ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in OR cover Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GLYBURIDE AND METFORMIN HCL 1.25-250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE AND METFORMIN HCL 1.25-250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GLYBURIDE TABLETS ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GLYBURIDE TABLETS ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
GLYCOPYRROLATE 0.2MG/ML VL ![Compare how all Medicare Part D PDP plans in OR cover GLYCOPYRROLATE 0.2MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GLYNASE 1.5MG PRESTAB ![Compare how all Medicare Part D PDP plans in OR cover GLYNASE 1.5MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLYNASE PRESTAB TABLET 3MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYNASE PRESTAB TABLET 3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYNASE PRESTAB TABLET 6MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GLYNASE PRESTAB TABLET 6MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GLYSET 100MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYSET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:3 /1Days |
GLYSET 25MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYSET 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:3 /1Days |
GLYSET 50MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYSET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | Q:3 /1Days |
GOLYTELY PACKET 227.1 GM/2.82 GM ![Compare how all Medicare Part D PDP plans in OR cover GOLYTELY PACKET 227.1 GM/2.82 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Gralise 300mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Gralise 300mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Gralise 600mg/1 90 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Gralise 600mg/1 90 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
Gralise Starter Pack 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in OR cover Gralise Starter Pack 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $238.00 | None |
GRANISETRON HCL 1MG TABLET (20 CT) ![Compare how all Medicare Part D PDP plans in OR cover GRANISETRON HCL 1MG TABLET (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | P |
granisetron hydrochloride 0.1mg/mL 1 VIAL, SINGLE-USE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in OR cover granisetron hydrochloride 0.1mg/mL 1 VIAL, SINGLE-USE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
Granisetron Hydrochloride 1mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 1 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in OR cover Granisetron Hydrochloride 1mg/mL 10 VIAL, SINGLE-USE in 1 TRAY / 1 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 |
Grifulvin V 500mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Grifulvin V 500mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GRIS-PEG 125MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GRIS-PEG 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $70.00 | None |
GRIS-PEG 250 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GRIS-PEG 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $70.00 | None |
Griseofulvin 125mg/5mL 120 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Griseofulvin 125mg/5mL 120 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
griseofulvin micro 500 mg tab ![Compare how all Medicare Part D PDP plans in OR cover griseofulvin micro 500 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
griseofulvin ultra 125 mg tab ![Compare how all Medicare Part D PDP plans in OR cover griseofulvin ultra 125 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
griseofulvin ultra 250 mg tab ![Compare how all Medicare Part D PDP plans in OR cover griseofulvin ultra 250 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |
GUANFACINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GUANFACINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
GUANFACINE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover GUANFACINE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$3.00 | $6.00 | P |
guanidine hcl 125 mg tablet ![Compare how all Medicare Part D PDP plans in OR cover guanidine hcl 125 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$10.00 | $20.00 | None |