2015 Medicare Part D Plan Formulary Information |
Rocky Mountain Thrifty Plan + Rx (Cost) (H0602-039-0)
Benefit Details
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The Rocky Mountain Thrifty Plan + Rx (Cost) (H0602-039-0) Formulary Drugs Starting with the Letter G in DENVER County, CO: CMS MA Region 20 which includes: CO Plan Monthly Premium: $89.40 Deductible: $75 |
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 CO cover GABAPENTIN 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Gabapentin 250mg/5mL 470 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GABAPENTIN 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CO cover GABAPENTIN 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GABAPENTIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GABAPENTIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GABAPENTIN CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in CO cover GABAPENTIN CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GABAPENTIN TABLET 800MG ![Compare how all Medicare Part D PDP plans in CO cover GABAPENTIN TABLET 800MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GABITRIL 12 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GABITRIL 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GABITRIL 16mg/1 ![Compare how all Medicare Part D PDP plans in CO cover GABITRIL 16mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GABITRIL 2mg/1 ![Compare how all Medicare Part D PDP plans in CO cover GABITRIL 2mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GABITRIL 4mg/1 ![Compare how all Medicare Part D PDP plans in CO cover GABITRIL 4mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Gablofen 2000ug/mL 20 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in CO cover Gablofen 2000ug/mL 20 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | P |
Gablofen 500ug/mL 20 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in CO cover Gablofen 500ug/mL 20 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | P |
Gablofen 50ug/mL 1 mL in 1 SYRINGE, PLASTIC ![Compare how all Medicare Part D PDP plans in CO cover Gablofen 50ug/mL 1 mL in 1 SYRINGE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | P |
Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT ![Compare how all Medicare Part D PDP plans in CO cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT ![Compare how all Medicare Part D PDP plans in CO cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT ![Compare how all Medicare Part D PDP plans in CO cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GamaSTAN S/D 0.165g/mL ![Compare how all Medicare Part D PDP plans in CO cover GamaSTAN S/D 0.165g/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS ![Compare how all Medicare Part D PDP plans in CO cover GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GAMMAKED 1 GRAM/10 ML VIAL ![Compare how all Medicare Part D PDP plans in CO cover GAMMAKED 1 GRAM/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GAMMAPLEX INJECTION 5 GM/100 ML ![Compare how all Medicare Part D PDP plans in CO cover GAMMAPLEX INJECTION 5 GM/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in CO cover Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GANCICLOVIR 500MG VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in CO cover GANCICLOVIR 500MG VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | P |
GARDASIL 9 SYRINGE ![Compare how all Medicare Part D PDP plans in CO cover GARDASIL 9 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GARDASIL 9 VIAL ![Compare how all Medicare Part D PDP plans in CO cover GARDASIL 9 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GARDASIL SYRINGE ![Compare how all Medicare Part D PDP plans in CO cover GARDASIL SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GARDASIL VIAL ![Compare how all Medicare Part D PDP plans in CO cover GARDASIL VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GASTROCROM 100MG/5ML CONC ![Compare how all Medicare Part D PDP plans in CO cover GASTROCROM 100MG/5ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid] ![Compare how all Medicare Part D PDP plans in CO cover GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAVILYTE-C SOLUTION ![Compare how all Medicare Part D PDP plans in CO cover GAVILYTE-C SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GAVILYTE-G SOLUTION ![Compare how all Medicare Part D PDP plans in CO cover GAVILYTE-G SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GAVILYTE-N SOLUTION ![Compare how all Medicare Part D PDP plans in CO cover GAVILYTE-N SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GELNIQUE 100mg/g 30 PACKET per CARTON / 1 g in 1 PACKET ![Compare how all Medicare Part D PDP plans in CO cover GELNIQUE 100mg/g 30 PACKET per CARTON / 1 g in 1 PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GELNIQUE 3% GEL ![Compare how all Medicare Part D PDP plans in CO cover GELNIQUE 3% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in CO cover Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GEMFIBROZIL TABLET 600MG (500 CT) ![Compare how all Medicare Part D PDP plans in CO cover GEMFIBROZIL TABLET 600MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GEMZAR 1GRAM VIAL ![Compare how all Medicare Part D PDP plans in CO cover GEMZAR 1GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
GENERLAC 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in CO cover GENERLAC 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENGRAF 100MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in CO cover GENGRAF 100MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in CO cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENGRAF 25MG CAPSULE U.D. ![Compare how all Medicare Part D PDP plans in CO cover GENGRAF 25MG CAPSULE U.D..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | P |
GENOTROPIN 13.8MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN 13.8MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN 5 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN 5 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 0.2MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 0.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 0.4MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 0.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 0.6MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 0.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 0.8MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 0.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 1.2MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 1.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 1.4MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 1.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 1.6MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 1.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 1.8MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 1.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENOTROPIN MINIQUICK 1MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENOTROPIN MINIQUICK 2MG ![Compare how all Medicare Part D PDP plans in CO cover GENOTROPIN MINIQUICK 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | P |
GENTAK 3MG/GM EYE OINTMENT ![Compare how all Medicare Part D PDP plans in CO cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN 100MG/NS 100ML ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN 100MG/NS 100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN 10MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN 10MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Gentamicin 3 mg/gm eye oint ![Compare how all Medicare Part D PDP plans in CO cover Gentamicin 3 mg/gm eye oint.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN 70MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN 70MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GENTAMICIN 80MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN 80MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN 90MG/NS 100ML PB ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN 90MG/NS 100ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | 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 CO 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* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | 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 CO 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* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in CO cover GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GEODON 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in CO cover GEODON 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GEODON 20MG VIAL ![Compare how all Medicare Part D PDP plans in CO cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GEODON 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in CO cover GEODON 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GEODON 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in CO cover GEODON 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GEODON 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in CO cover GEODON 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in CO cover Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
gildagia 0.4 mg-0.035 mg tab ![Compare how all Medicare Part D PDP plans in CO cover gildagia 0.4 mg-0.035 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Gildess 1.5 mg-30 mcg tablet ![Compare how all Medicare Part D PDP plans in CO cover Gildess 1.5 mg-30 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Gildess 24 fe 1-20 Tablet ![Compare how all Medicare Part D PDP plans in CO cover Gildess 24 fe 1-20 Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Gilenya 0.5mg/1 28 CAPSULE per CARTON ![Compare how all Medicare Part D PDP plans in CO cover Gilenya 0.5mg/1 28 CAPSULE per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | P |
GILOTRIF 20 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GILOTRIF 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GILOTRIF 30 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GILOTRIF 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GILOTRIF 40 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GILOTRIF 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GLASSIA 1g/50mL 1 VIAL, GLASS per CARTON / 50 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in CO cover GLASSIA 1g/50mL 1 VIAL, GLASS per CARTON / 50 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GLEEVEC 100MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLEEVEC 100MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GLEEVEC 400MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLEEVEC 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
GLIMEPIRIDE 1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLIMEPIRIDE 1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$3.00 | $7.50 | None |
GLIMEPIRIDE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLIMEPIRIDE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$3.00 | $7.50 | None |
GLIMEPIRIDE 4MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLIMEPIRIDE 4MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$3.00 | $7.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLIPIZIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLIPIZIDE 10MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE 10MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE 5MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Glipizide 5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Glipizide 5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
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 CO 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* |
Tier 2 |
$25.00 | $62.50 | None |
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLIPIZIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in CO cover GLIPIZIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in CO cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in CO cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GLUCOPHAGE 1000MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOPHAGE 1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUCOPHAGE 500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOPHAGE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOPHAGE 850MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOPHAGE 850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOPHAGE XR 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in CO cover GLUCOPHAGE XR 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOPHAGE XR 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in CO cover GLUCOPHAGE XR 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOTROL 10MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOTROL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOTROL 5MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOTROL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOTROL XL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOTROL XL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOTROL XL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOTROL XL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOTROL XL 5MG TABLET SA ![Compare how all Medicare Part D PDP plans in CO cover GLUCOTROL XL 5MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOVANCE 2.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOVANCE 2.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUCOVANCE 5/500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUCOVANCE 5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUMETZA ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUMETZA ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLUMETZA ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLUMETZA ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLYBURIDE 1.25MG TABLETS ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE 1.25MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE 5MG TABLETS ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CO cover Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE AND METFORMIN HCL 1.25-250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO 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 |
$25.00 | $62.50 | None |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYCOPYRROLATE 0.2MG/ML VL ![Compare how all Medicare Part D PDP plans in CO cover GLYCOPYRROLATE 0.2MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GLYNASE 1.5MG PRESTAB ![Compare how all Medicare Part D PDP plans in CO cover GLYNASE 1.5MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Glynase 3mg/1 1000 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CO cover Glynase 3mg/1 1000 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Glynase 6mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CO cover Glynase 6mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLYSET 100MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYSET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLYSET 25MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYSET 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLYSET 50MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYSET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GLYXAMBI 10 MG-5 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYXAMBI 10 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GLYXAMBI 25 MG-5 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GLYXAMBI 25 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GOLYTELY PACKET 227.1 GM/2.82 GM ![Compare how all Medicare Part D PDP plans in CO cover GOLYTELY PACKET 227.1 GM/2.82 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM ![Compare how all Medicare Part D PDP plans in CO cover GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Granisetron HCl 0.1 mg/ml vial ![Compare how all Medicare Part D PDP plans in CO cover Granisetron HCl 0.1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | P |
Granisetron Hydrochloride 1mg/mL 10 VIAL, SINGLE-USE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in CO cover Granisetron Hydrochloride 1mg/mL 10 VIAL, SINGLE-USE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GRANIX 300 MCG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in CO cover GRANIX 300 MCG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
GRANIX 480 MCG/0.8 ML SYRINGE ![Compare how all Medicare Part D PDP plans in CO cover GRANIX 480 MCG/0.8 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
GRASTEK 2;800 BAU SL TABLET ![Compare how all Medicare Part D PDP plans in CO cover GRASTEK 2;800 BAU SL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | P |
GRIS-PEG 125MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GRIS-PEG 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
GRIS-PEG 250 MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GRIS-PEG 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Griseofulvin 125mg/5mL 120 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in CO cover Griseofulvin 125mg/5mL 120 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
griseofulvin micro 500 mg tab ![Compare how all Medicare Part D PDP plans in CO cover griseofulvin micro 500 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
griseofulvin ultra 125 mg tab ![Compare how all Medicare Part D PDP plans in CO cover griseofulvin ultra 125 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
griseofulvin ultra 250 mg tab ![Compare how all Medicare Part D PDP plans in CO cover griseofulvin ultra 250 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GUANFACINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in CO cover GUANFACINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
GUANFACINE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CO cover GUANFACINE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$25.00 | $62.50 | None |
Guanfacine hcl er 1 mg tablet ![Compare how all Medicare Part D PDP plans in CO cover Guanfacine hcl er 1 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Guanfacine hcl er 2 mg tablet ![Compare how all Medicare Part D PDP plans in CO cover Guanfacine hcl er 2 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Guanfacine hcl er 3 mg tablet ![Compare how all Medicare Part D PDP plans in CO cover Guanfacine hcl er 3 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
Guanfacine hcl er 4 mg tablet ![Compare how all Medicare Part D PDP plans in CO cover Guanfacine hcl er 4 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |
guanidine hcl 125 mg tablet ![Compare how all Medicare Part D PDP plans in CO cover guanidine hcl 125 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$40.00 | $100.00 | None |
GYNAZOLE-1 2% CREAM ![Compare how all Medicare Part D PDP plans in CO cover GYNAZOLE-1 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$90.00 | $225.00 | None |