2015 Medicare Part D Plan Formulary Information |
ATRIO Silver Rx (Willamette) (PPO) (H7006-003-0)
Benefit Details
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The ATRIO Silver Rx (Willamette) (PPO) (H7006-003-0) Formulary Drugs Starting with the Letter G in MARION County, OR: CMS MA Region 23 which includes: OR Plan Monthly Premium: $64.00 Deductible: $150 |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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) |
3 |
Preferred Brand |
$40.00 | $80.00 | 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) |
3 |
Preferred Brand |
$40.00 | $80.00 | None |
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 |
$15.00 | $30.00 | Q:60 /30Days |
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 |
$15.00 | $30.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$15.00 | $30.00 | Q:60 /30Days |
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 |
$15.00 | $30.00 | Q:30 /30Days |
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 |
$15.00 | $30.00 | Q:30 /30Days |
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 |
$15.00 | $30.00 | Q:30 /30Days |
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 |
$15.00 | $30.00 | Q:200 /30Days |
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) |
3 |
Preferred Brand |
$40.00 | $80.00 | P |
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per 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 per CARTON / 25 mL in 1 BOTTLE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | 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 |
29% | 29% | 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 |
29% | 29% | P |
GANCICLOVIR 500MG VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in OR cover GANCICLOVIR 500MG VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P |
GARDASIL 9 SYRINGE ![Compare how all Medicare Part D PDP plans in OR cover GARDASIL 9 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Vaccines |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GARDASIL 9 VIAL ![Compare how all Medicare Part D PDP plans in OR cover GARDASIL 9 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Vaccines |
$0.00 | $0.00 | None |
GARDASIL SYRINGE ![Compare how all Medicare Part D PDP plans in OR cover GARDASIL SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Vaccines |
$0.00 | $0.00 | 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) |
6* |
Vaccines |
$0.00 | $0.00 | None |
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid] ![Compare how all Medicare Part D PDP plans in OR cover GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
GAVILYTE-C SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover GAVILYTE-C SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
GAVILYTE-G SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover GAVILYTE-G SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
GAVILYTE-N SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover GAVILYTE-N SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in OR 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) |
5 |
Specialty Tier |
29% | 29% | 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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
$85.00 | $170.00 | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
29% | 29% | P |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | None |
Gentamicin 3 mg/gm eye oint ![Compare how all Medicare Part D PDP plans in OR cover Gentamicin 3 mg/gm eye oint.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
GENTAMICIN 70MG/NS 50ML PB ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN 70MG/NS 50ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | None |
GENTAMICIN 90MG/NS 100ML PB ![Compare how all Medicare Part D PDP plans in OR cover GENTAMICIN 90MG/NS 100ML PB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
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 |
$15.00 | $30.00 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$85.00 | $170.00 | Q:6 /28Days |
Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in OR 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 |
Non-Preferred Generic |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | None |
Gildess 1.5 mg-30 mcg tablet ![Compare how all Medicare Part D PDP plans in OR cover Gildess 1.5 mg-30 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Gildess 24 fe 1-20 Tablet ![Compare how all Medicare Part D PDP plans in OR cover Gildess 24 fe 1-20 Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Gilenya 0.5mg/1 28 CAPSULE per CARTON ![Compare how all Medicare Part D PDP plans in OR cover Gilenya 0.5mg/1 28 CAPSULE per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | P Q:28 /28Days |
GILOTRIF 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GILOTRIF 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GILOTRIF 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GILOTRIF 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | P Q:30 /30Days |
GILOTRIF 40 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GILOTRIF 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | P Q:30 /30Days |
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 |
29% | 29% | P Q:90 /30Days |
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 |
29% | 29% | P Q:60 /30Days |
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 |
$6.00 | $12.00 | Q:30 /30Days |
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 |
$6.00 | $12.00 | Q:30 /30Days |
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 |
$6.00 | $12.00 | Q:60 /30Days |
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 |
$6.00 | $12.00 | Q:120 /30Days |
GLIPIZIDE 10MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE 10MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | Q:60 /30Days |
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE 5MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | Q:30 /30Days |
Glipizide 5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Glipizide 5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$6.00 | $12.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$15.00 | $30.00 | Q:60 /30Days |
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 |
$15.00 | $30.00 | Q:30 /30Days |
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 |
$15.00 | $30.00 | Q:120 /30Days |
GLIPIZIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in OR cover GLIPIZIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | Q:120 /30Days |
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 |
$40.00 | $80.00 | 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) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | None |
GLYBURIDE 1.25MG TABLETS ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE 1.25MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:280 /30Days |
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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:240 /30Days |
GLYBURIDE 5MG TABLETS ![Compare how all Medicare Part D PDP plans in OR cover GLYBURIDE 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:120 /30Days |
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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:120 /30Days |
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 |
$15.00 | $30.00 | P Q:240 /30Days |
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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:180 /30Days |
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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P Q:400 /30Days |
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 |
$15.00 | $30.00 | P Q:120 /30Days |
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 |
$15.00 | $30.00 | P Q:120 /30Days |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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) |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:90 /30Days |
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) |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:90 /30Days |
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) |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:90 /30Days |
GLYXAMBI 10 MG-5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYXAMBI 10 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYXAMBI 25 MG-5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover GLYXAMBI 25 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $80.00 | Q:30 /30Days |
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 |
$85.00 | $170.00 | S Q:90 /30Days |
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 |
$85.00 | $170.00 | S Q:90 /30Days |
Gralise Starter Pack 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in OR cover Gralise Starter Pack 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$85.00 | $170.00 | S Q:78 /30Days |
Granisetron HCl 0.1 mg/ml vial ![Compare how all Medicare Part D PDP plans in OR cover Granisetron HCl 0.1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | 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 OR 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 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
GRANIX 300 MCG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in OR cover GRANIX 300 MCG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | None |
GRANIX 480 MCG/0.8 ML SYRINGE ![Compare how all Medicare Part D PDP plans in OR cover GRANIX 480 MCG/0.8 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | 29% | 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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$15.00 | $30.00 | 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 |
$15.00 | $30.00 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | 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) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | P |
Guanfacine hcl er 1 mg tablet ![Compare how all Medicare Part D PDP plans in OR cover Guanfacine hcl er 1 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Guanfacine hcl er 2 mg tablet ![Compare how all Medicare Part D PDP plans in OR cover Guanfacine hcl er 2 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Guanfacine hcl er 3 mg tablet ![Compare how all Medicare Part D PDP plans in OR cover Guanfacine hcl er 3 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
Guanfacine hcl er 4 mg tablet ![Compare how all Medicare Part D PDP plans in OR cover Guanfacine hcl er 4 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$15.00 | $30.00 | None |
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 |
$15.00 | $30.00 | None |