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2016 Medicare Part D and Medicare Advantage Plan Formulary Browser

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AARP MedicareRx Preferred (PDP) (S5820-028-0)
Tier 1 (124)
Tier 2 (660)
Tier 3 (1183)
Tier 4 (1031)
Tier 5 (593)
Requires Prior Authorization:
Yes No Show either
Uses Step Therapy:
Yes No Show either
Has Quantity Limits:
Yes No Show either
  *required
 
Cick on the first letter of your drug name to browse the formulary:

A B C D E F G H I J K L 
M N O P Q R S T U V W X Y Z 0-9 
2016 Medicare Part D Plan Formulary Information
AARP MedicareRx Preferred (PDP) (S5820-028-0)
Benefit Details           
The AARP MedicareRx Preferred (PDP) (S5820-028-0)
Formulary Drugs Starting with the Letter G

in CMS PDP Region 29 which includes: NV
Plan Monthly Premium: $64.50 Deductible: $0 Qualifies for LIS: No
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   2 Generic $10.00$0.00None
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE   3 Preferred Brand $35.00$90.00None
GABAPENTIN 400 MG CAPSULE   2 Generic $10.00$0.00None
GABAPENTIN 600MG TABLET   2 Generic $10.00$0.00None
GABAPENTIN CAPSULES 300MG   2 Generic $10.00$0.00None
GABAPENTIN TABLET 800MG   2 Generic $10.00$0.00None
GABITRIL 12 MG TABLET   4 Non-Preferred Brand 40%40%Q:120
/30Days
GABITRIL 16mg/1   4 Non-Preferred Brand 40%40%Q:90
/30Days
Gablofen 2000ug/mL 20 mL in 1 VIAL, GLASS   4 Non-Preferred Brand 40%40%P
Gablofen 500ug/mL 20 mL in 1 VIAL, GLASS   4 Non-Preferred Brand 40%40%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Gablofen 50ug/mL 1 mL in 1 SYRINGE, PLASTIC   4 Non-Preferred Brand 40%40%P
Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE   3 Preferred Brand $35.00$90.00Q:60
/30Days
Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE   3 Preferred Brand $35.00$90.00Q:60
/30Days
Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE   3 Preferred Brand $35.00$90.00Q:60
/30Days
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT   3 Preferred Brand $35.00$90.00Q:30
/30Days
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT   3 Preferred Brand $35.00$90.00Q:30
/30Days
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 8MG 30 BOT   3 Preferred Brand $35.00$90.00Q:30
/30Days
Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE   3 Preferred Brand $35.00$90.00Q:200
/30Days
GamaSTAN S/D 0.165g/mL   3 Preferred Brand $35.00$90.00P
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS   4 Non-Preferred Brand 40%40%P
GAMMAKED 1 GRAM/10 ML VIAL   4 Non-Preferred Brand 40%40%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GAMMAPLEX INJECTION 5 GM/100 ML   4 Non-Preferred Brand 40%40%P
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS   4 Non-Preferred Brand 40%40%P
GANCICLOVIR 500MG VIAL FOR INJECTION   4 Non-Preferred Brand 40%40%P
GARDASIL 9 SYRINGE   3 Preferred Brand $35.00$90.00None
GARDASIL 9 VIAL   3 Preferred Brand $35.00$90.00None
GARDASIL SYRINGE   3 Preferred Brand $35.00$90.00None
GARDASIL VIAL   3 Preferred Brand $35.00$90.00None
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid]   3 Preferred Brand $35.00$90.00None
GATTEX 5 MG ONE-VIAL KIT   5 Specialty Tier 33%33%P
GAVILYTE-C SOLUTION   2 Generic $10.00$0.00None
GAVILYTE-G SOLUTION   2 Generic $10.00$0.00None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GAVILYTE-H AND BISACODYL KIT   3 Preferred Brand $35.00$90.00None
GAVILYTE-N SOLUTION   2 Generic $10.00$0.00None
Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL   5 Specialty Tier 33%33%None
GEMFIBROZIL TABLET 600MG (500 CT)   2 Generic $10.00$0.00None
GENERLAC 10 GM/15 ML SOLUTION   2 Generic $10.00$0.00None
GENGRAF 100 MG CAPSULE   3 Preferred Brand $35.00$90.00P
GENGRAF 100MG/ML SOLUTION   3 Preferred Brand $35.00$90.00P
GENGRAF 25 MG CAPSULE   3 Preferred Brand $35.00$90.00P
GENOTROPIN 13.8MG CARTRIDGE   4 Non-Preferred Brand 40%40%P
GENOTROPIN 5 MG CARTRIDGE   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 0.2MG   4 Non-Preferred Brand 40%40%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GENOTROPIN MINIQUICK 0.4MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 0.6MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 0.8MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 1.2MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 1.4MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 1.6MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 1.8MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 1MG   4 Non-Preferred Brand 40%40%P
GENOTROPIN MINIQUICK 2MG   4 Non-Preferred Brand 40%40%P
GENTAK 3MG/GM EYE OINTMENT   2 Generic $10.00$0.00None
GENTAMICIN 100MG/NS 100ML   4 Non-Preferred Brand 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GENTAMICIN 10MG/ML VIAL   4 Non-Preferred Brand 40%40%None
Gentamicin 3 mg/gm eye oint   2 Generic $10.00$0.00None
GENTAMICIN 70MG/NS 50ML PB   4 Non-Preferred Brand 40%40%None
GENTAMICIN 80MG/NS 50ML PB   4 Non-Preferred Brand 40%40%None
GENTAMICIN 90MG/NS 100ML PB   4 Non-Preferred Brand 40%40%None
Gentamicin Sulfate 40mg/mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 2 mL in 1 VIAL, SINGLE-DOSE   4 Non-Preferred Brand 40%40%None
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE   2 Generic $10.00$0.00None
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG   4 Non-Preferred Brand 40%40%None
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE   2 Generic $10.00$0.00None
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT   2 Generic $10.00$0.00None
GENVOYA TABLET   5 Specialty Tier 33%33%Q:60
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GEODON 20MG VIAL   4 Non-Preferred Brand 40%40%None
Gianvi 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK   3 Preferred Brand $35.00$90.00None
gildagia 0.4 mg-0.035 mg tab   3 Preferred Brand $35.00$90.00None
Gildess 1.5 mg-30 mcg tablet   3 Preferred Brand $35.00$90.00None
Gildess 24 fe 1-20 Tablet   3 Preferred Brand $35.00$90.00None
GILENYA 0.5 MG CAPSULE   5 Specialty Tier 33%33%P Q:30
/30Days
GILOTRIF 20 MG TABLET   5 Specialty Tier 33%33%P
GILOTRIF 30 MG TABLET   5 Specialty Tier 33%33%P
GILOTRIF 40 MG TABLET   5 Specialty Tier 33%33%P
Glatopa 20 mg/ml syringe   5 Specialty Tier 33%33%P
GLEOSTINE 10 MG CAPSULE   4 Non-Preferred Brand 40%40%None
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GLEOSTINE 100 MG CAPSULE   4 Non-Preferred Brand 40%40%None
GLEOSTINE 40 MG CAPSULE   4 Non-Preferred Brand 40%40%None
GLEOSTINE 5 MG CAPSULE   4 Non-Preferred Brand 40%40%None
GLIMEPIRIDE 1MG TABLET (100 CT)   1 Preferred Generic $5.00$0.00Q:240
/30Days
GLIMEPIRIDE 2MG TABLET (100 CT)   1 Preferred Generic $5.00$0.00Q:120
/30Days
GLIMEPIRIDE 4MG TABLET (100 CT)   1 Preferred Generic $5.00$0.00Q:60
/30Days
GLIPIZIDE 10MG TABLET (100 CT)   1 Preferred Generic $5.00$0.00Q:120
/30Days
GLIPIZIDE 10MG TABLETS EXTENDED RELEASE   1 Preferred Generic $5.00$0.00Q:60
/30Days
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE   1 Preferred Generic $5.00$0.00Q:120
/30Days
Glipizide 5mg/1 500 TABLET BOTTLE   1 Preferred Generic $5.00$0.00Q:240
/30Days
Glipizide and Metformin Hydrochloride 2.5; 250mg/1; mg/1 100 BOTTLE, PLASTIC in 1 BOTTLE, PLASTIC /   1 Preferred Generic $5.00$0.00Q:240
/30Days
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR   1 Preferred Generic $5.00$0.00Q:240
/30Days
GLIPIZIDE-METFORMIN 2.5-500MG TABLET   1 Preferred Generic $5.00$0.00Q:120
/30Days
GLIPIZIDE-METFORMIN 5-500 MG   1 Preferred Generic $5.00$0.00Q:120
/30Days
GLUCAGEN 1MG HYPOKIT   4 Non-Preferred Brand 40%40%None
GLUCAGON 1MG EMERGENCY KIT   3 Preferred Brand $35.00$90.00None
GLYCOPYRROLATE 0.2MG/ML VL   4 Non-Preferred Brand 40%40%None
Granisetron HCl 0.1 mg/ml vial   4 Non-Preferred Brand 40%40%None
Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE   4 Non-Preferred Brand 40%40%P Q:60
/30Days
Granisetron Hydrochloride 1mg/mL 10 VIAL, SINGLE-USE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-USE   4 Non-Preferred Brand 40%40%None
GRANIX 300 MCG/0.5 ML SYRINGE   5 Specialty Tier 33%33%P
GRANIX 480 MCG/0.8 ML SYRINGE   5 Specialty Tier 33%33%P
Drug Name Tier
Nbr.
Tier
Description
30-Day
Preferred
Pharm
90-Day
Mail
Order
Drug
Usage
Mgmt
Griseofulvin 125mg/5mL 120 mL in 1 BOTTLE   4 Non-Preferred Brand 40%40%None
griseofulvin micro 500 mg tab   4 Non-Preferred Brand 40%40%None
griseofulvin ultra 125 mg tab   4 Non-Preferred Brand 40%40%None
griseofulvin ultra 250 mg tab   4 Non-Preferred Brand 40%40%None
Guanfacine hcl er 1 mg tablet   4 Non-Preferred Brand 40%40%None
Guanfacine hcl er 2 mg tablet   4 Non-Preferred Brand 40%40%None
Guanfacine hcl er 3 mg tablet   4 Non-Preferred Brand 40%40%None
Guanfacine hcl er 4 mg tablet   4 Non-Preferred Brand 40%40%None
guanidine hcl 125 mg tablet   3 Preferred Brand $35.00$90.00None

Chart Legend:

Below are a few notes to help you understand the above 2016 Medicare Part D AARP MedicareRx Preferred (PDP) Plan Formulary.
  • Plan Name: This is the official Medicare Part D prescription drug plan name from the Centers for Medicare and Medicaid Services (CMS). The same Medicare Part D plan name generally has a different Plan ID in each state (or CMS Region).

  • Monthly Premium: This is the amount you must pay each month for this prescription drug plan. This monthly premium must be paid even if you are in the initial deductible phase or the coverage gap (donut hole) phase.

  • Deductible: If your Part D plan has an initial deductible, you are 100% responsible for your drug costs until your expenses exceed this value and you begin your Initial Coverage Phase. Many Medicare Part D plans use the the standard $360 deductible as provided by CMS in their Standard plan design. Some Part D plan providers offer an initial deductible lower than the Standard deductible. Many prescription drug plans do not have a deductible (also called first dollar coverage or a $0 deductible), however the monthly premium for a plan with a $0 deductible may be slightly higher.

  • Qualifies for LIS: The Extra Help or Low Income Subsidy (LIS) Program.
    • Yes - This plan qualifies for the $0 Premium for those persons with a full LIS or Extra Help benefit. Persons on the LIS program who select a qualifying plan will also pay a $0 deductible, pay lower cost-sharing payments and have coverage through the Coverage Gap or Doughnut Hole.

    • No - This plan does not qualify for the $0 Premium for persons wit the full LIS benefit.

  • Plan ID: This is the Medicare Part D prescription drug plan's unique ID.
  • Drug Tier Information - Drug Tiers are the logical grouping of prescription drugs on a Part D plan formulary. These fields represent the Tier (or drug list group) - for this particular medication - on this particular plan’s Formulary or Drug List.
    • Tier Number - This is the actual numerical tier level from the formulary. Most Part D plans have four (4) tiers 1=Preferred Generics, 2=Preferred Brands, 3=Non-preferred Brands and Generics, 4=Specialty Drugs.
    • Drug Description - This is the Medicare Part D plan’s description of this particular drug tier.
  • Cost Sharing - Copay / Coinsurance - These figures apply to the initial coverage phase of your plan. This is the phase after the initial deductible has been met and before you reach the Coverage Gap (Donut Hole). Plans often cover drugs in "tiers". Tiers are specific to the list of drugs covered by the plan. Plans may have several tiers, and the copay for a drug depends on which tier the drug is in. The drug Tier is shown to the left of this column. These cost sharing figures DO NOT necessarily apply to the Coverage Gap. The plan may have a separate copay/coinsurance for the same drug while in the Coverage Gap. There are two figures shown under this "Cost Sharing" category:
    • Preferred Network Pharmacy - (Preferred Pharm) - This is the cost-share amount you would pay during the intial coverage phase for a 30-Day supply (until your total retail prescription drug costs reach $3310) at a "Preferred" network pharmacy. In most cases, the "Preferred" network and network pharmacy pricing are the same. However, for example on the 2016 Humana Walmart-Preferred Rx Plan the cost-sharing is much higher at a network pharmacy over a "Preferred" network pharmacy. "Preferred" network pharmacies for this plan include only Walmart, Sam’s Club and RightSource.
    • Mail Order - This is the cost-share amount you would pay during the initial coverage phase for a 90-Day supply if you purchased your medication through your plan’s preferred mail order partner(s).
  • Drug Utilization Management or Coverage Rules - (Drug Usage Mgmt) - This shows the plan requires drug utilization management controls for this particular medication.
    • None - This drug does not fall under any drug utilization management controls.
    • P - Prior Authorization -This drug is subject to prior authorization.
    • S - Step Therapy -This drug is subject to step therapy.
    • Q - Quantity Limits -This drug is subject to quantity limits. The actual quantity limit is shown as Q:Amount/Days. For Example: Q:6/28Days means the quantity limit is a quantity of 6 pills per 28 days. Q:90/365Days would mean that the plan limits this drug to 90 pills for the entire year.




(Chart Source: Centers for Medicare and Medicaid files: CMS Data September 2016 )

Please note: The above plan information comes from CMS. We make every attempt to keep our information up-to-date with plan/premium changes. However, the Medicare Part D plan data changes over time and we cannot guarantee the accuracy of this information. You should always verify cost and coverage information with your Part D plan provider.







Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.