2017 Medicare Part D Plan Formulary Information |
Medicare Blue Choice Optimum (HMO-POS) (H3351-006-0)
Benefit Details
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The Medicare Blue Choice Optimum (HMO-POS) (H3351-006-0) Formulary Drugs Starting with the Letter G in Monroe County, NY: CMS MA Region 3 which includes: NY Plan Monthly Premium: $230.00 Deductible: $0 |
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 NY cover GABAPENTIN 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Gabapentin 250mg/5mL 470 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GABAPENTIN 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GABAPENTIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GABAPENTIN CAPSULES 300MG ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN CAPSULES 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GABAPENTIN TABLET 800MG ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN TABLET 800MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GABITRIL 12 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GABITRIL 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GABITRIL 16mg/1 ![Compare how all Medicare Part D PDP plans in NY cover GABITRIL 16mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Galantamine 12mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:60 /30Days |
Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Galantamine 4mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | 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 NY cover Galantamine 8mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:60 /30Days |
GALANTAMINE ER 8 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE ER 8 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:30 /30Days |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 16MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:30 /30Days |
GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE HYDROBROMIDE CAPSULES EXTENDED RELEASE 24MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:30 /30Days |
Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Galantamine Hydrobromide Oral Solution 4mg/mL 100 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GAMMAGARD LIQUID 100mg/mL 1 BOTTLE, GLASS per CARTON / 25 mL in 1 BOTTLE, GLASS ![Compare how all Medicare Part D PDP plans in NY 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 |
33% | N/A | P |
GAMMAGARD S-D 10 G (IGA<1) SOL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAGARD S-D 10 G (IGA<1) SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAMMAGARD S-D 5 G (IGA<1) SOLN ![Compare how all Medicare Part D PDP plans in NY cover GAMMAGARD S-D 5 G (IGA<1) SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAMMAKED 1 GRAM/10 ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAKED 1 GRAM/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAMMAPLEX 10 GRAM/100 ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAPLEX 10 GRAM/100 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAMMAPLEX 20 GRAM/200 ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAPLEX 20 GRAM/200 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAMMAPLEX 5 GRAM/50 ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAPLEX 5 GRAM/50 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAMMAPLEX INJECTION 5 GM/100 ML ![Compare how all Medicare Part D PDP plans in NY cover GAMMAPLEX INJECTION 5 GM/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in NY 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% | N/A | P |
GANCICLOVIR 500MG VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in NY cover GANCICLOVIR 500MG VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P |
GARDASIL 9 SYRINGE ![Compare how all Medicare Part D PDP plans in NY cover GARDASIL 9 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GARDASIL 9 VIAL ![Compare how all Medicare Part D PDP plans in NY cover GARDASIL 9 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GASTROCROM 100 MG/5 ML CONC ![Compare how all Medicare Part D PDP plans in NY cover GASTROCROM 100 MG/5 ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid] ![Compare how all Medicare Part D PDP plans in NY cover GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:5 /25Days |
GATTEX 5 MG ONE-VIAL KIT ![Compare how all Medicare Part D PDP plans in NY cover GATTEX 5 MG ONE-VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GAVILYTE-C SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover GAVILYTE-C SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GAVILYTE-G SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover GAVILYTE-G SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAVILYTE-H AND BISACODYL KIT ![Compare how all Medicare Part D PDP plans in NY cover GAVILYTE-H AND BISACODYL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GAVILYTE-N SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover GAVILYTE-N SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GELNIQUE 100mg/g 30 PACKET per CARTON / 1 g in 1 PACKET ![Compare how all Medicare Part D PDP plans in NY 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 |
Non-Preferred Drug |
$100.00 | N/A | Q:30 /30Days |
Gemcitabine Hydrochloride 1g/25mL 1 VIAL per CARTON / 25 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in NY 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 |
33% | N/A | None |
GEMFIBROZIL TABLET 600MG (500 CT) ![Compare how all Medicare Part D PDP plans in NY cover GEMFIBROZIL TABLET 600MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GEMZAR 1GRAM VIAL ![Compare how all Medicare Part D PDP plans in NY cover GEMZAR 1GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GENERESS FE CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in NY cover GENERESS FE CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GENERLAC 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover GENERLAC 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GENGRAF 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GENGRAF 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in NY cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
GENGRAF 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GENGRAF 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GENGRAF 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GENGRAF 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
GENOTROPIN 13.8MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN 13.8MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN 5 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN 5 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 0.2MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 0.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P |
GENOTROPIN MINIQUICK 0.4MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 0.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 0.6MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 0.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 0.8MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 0.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 1.2MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 1.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 1.4MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 1.4MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 1.6MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 1.6MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 1.8MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 1.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | 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 NY cover GENOTROPIN MINIQUICK 1MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 2MG ![Compare how all Medicare Part D PDP plans in NY cover GENOTROPIN MINIQUICK 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENTAK 3MG/GM EYE OINTMENT ![Compare how all Medicare Part D PDP plans in NY cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
Gentamicin 10 mg/ml vial ![Compare how all Medicare Part D PDP plans in NY cover Gentamicin 10 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | 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 NY 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 |
Generic |
$12.00 | N/A | None |
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in NY cover GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in NY 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 |
Generic |
$12.00 | N/A | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in NY cover GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in NY cover GENTAMICIN SULFATE OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GENVOYA TABLET ![Compare how all Medicare Part D PDP plans in NY cover GENVOYA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
GEODON 20MG VIAL ![Compare how all Medicare Part D PDP plans in NY cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Gianvi 3 mg-0.02 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover Gianvi 3 mg-0.02 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GIAZO 180 GM ![Compare how all Medicare Part D PDP plans in NY cover GIAZO 180 GM .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
gildagia 0.4 mg-0.035 mg tab ![Compare how all Medicare Part D PDP plans in NY cover gildagia 0.4 mg-0.035 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GILENYA 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GILENYA 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
GILOTRIF 20 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GILOTRIF 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
GILOTRIF 30 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GILOTRIF 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
GILOTRIF 40 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GILOTRIF 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
GLASSIA 1g/50mL 1 VIAL, GLASS per CARTON / 50 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in NY 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 |
Specialty Tier |
33% | N/A | P |
Glatopa 20 mg/ml syringe ![Compare how all Medicare Part D PDP plans in NY cover Glatopa 20 mg/ml syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
GLEEVEC 100MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLEEVEC 100MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
GLEEVEC 400 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLEEVEC 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLEOSTINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GLEOSTINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLEOSTINE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GLEOSTINE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLEOSTINE 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GLEOSTINE 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLEOSTINE 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GLEOSTINE 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLIMEPIRIDE 1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLIMEPIRIDE 1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:180 /30Days |
GLIMEPIRIDE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLIMEPIRIDE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:90 /30Days |
GLIMEPIRIDE 4MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLIMEPIRIDE 4MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:60 /30Days |
GLIPIZIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:120 /30Days |
GLIPIZIDE 10MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE 10MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:60 /30Days |
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE 5MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:90 /30Days |
Glipizide 5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Glipizide 5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:120 /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 NY 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 |
Generic |
$12.00 | N/A | Q:240 /30Days |
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | N/A | Q:90 /30Days |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:120 /30Days |
GLIPIZIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in NY cover GLIPIZIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:120 /30Days |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in NY cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in NY cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
GLUCOVANCE 2.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOVANCE 2.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:120 /30Days |
GLUCOVANCE 5/500MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOVANCE 5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:120 /30Days |
GLUMETZA ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUMETZA ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
GLUMETZA ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUMETZA ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
Glyburide 1.25 MG / Metformin hydrochloride 250 MG Oral Tablet [Glucovance] ![Compare how all Medicare Part D PDP plans in NY cover Glyburide 1.25 MG / Metformin hydrochloride 250 MG Oral Tablet [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYBURIDE 1.25MG TABLETS ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE 1.25MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:60 /30Days |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:90 /30Days |
GLYBURIDE 5MG TABLETS ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:120 /30Days |
Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NY cover Glyburide 6mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:60 /30Days |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:60 /30Days |
GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE MICRONIZED 1.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:60 /30Days |
GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET [Glucovance] ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE-METFORMIN HCL 2.5-500MG TABLET [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:120 /30Days |
GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET [Glucovance] ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE-METFORMIN HCL 5MG-500MG TABLET [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:120 /30Days |
GLYCOPYRROLATE 0.2MG/ML VL ![Compare how all Medicare Part D PDP plans in NY cover GLYCOPYRROLATE 0.2MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYNASE 1.5MG PRESTAB ![Compare how all Medicare Part D PDP plans in NY cover GLYNASE 1.5MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:60 /30Days |
Glynase 3mg/1 1000 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in NY cover Glynase 3mg/1 1000 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:60 /30Days |
GLYNASE 6 MG PRESTAB ![Compare how all Medicare Part D PDP plans in NY cover GLYNASE 6 MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:60 /30Days |
GLYSET 100MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLYSET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLYSET 25MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLYSET 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GLYSET 50MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLYSET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
GONITRO 0.4 MG SUBLINGUAL PWD ![Compare how all Medicare Part D PDP plans in NY cover GONITRO 0.4 MG SUBLINGUAL PWD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |
Gralise 600 MG 90 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Gralise 600 MG 90 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:90 /30Days |
GRALISE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GRALISE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P Q:60 /30Days |
Gralise Starter Pack 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in NY cover Gralise Starter Pack 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
Granisetron HCl 0.1 mg/ml vial ![Compare how all Medicare Part D PDP plans in NY cover Granisetron HCl 0.1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Granisetron hcl 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in NY cover Granisetron hcl 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:60 /30Days |
Granisetron hcl 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in NY cover Granisetron hcl 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | Q:60 /30Days |
Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in NY cover Granisetron Hydrochloride 1mg/1 2 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P Q:60 /30Days |
GRANIX 300 MCG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in NY cover GRANIX 300 MCG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
GRANIX 480 MCG/0.8 ML SYRINGE ![Compare how all Medicare Part D PDP plans in NY cover GRANIX 480 MCG/0.8 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
GRASTEK 2;800 BAU SL TABLET ![Compare how all Medicare Part D PDP plans in NY cover GRASTEK 2;800 BAU SL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | P |
GRISEOFULVIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in NY cover GRISEOFULVIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
griseofulvin micro 500 mg tab ![Compare how all Medicare Part D PDP plans in NY cover griseofulvin micro 500 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
griseofulvin ultra 125 mg tab ![Compare how all Medicare Part D PDP plans in NY cover griseofulvin ultra 125 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
griseofulvin ultra 250 mg tab ![Compare how all Medicare Part D PDP plans in NY cover griseofulvin ultra 250 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
GUANFACINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GUANFACINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GUANFACINE 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in NY cover GUANFACINE 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$12.00 | N/A | P |
Guanfacine hcl er 1 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover Guanfacine hcl er 1 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
Guanfacine hcl er 2 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover Guanfacine hcl er 2 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
Guanfacine hcl er 3 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover Guanfacine hcl er 3 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
Guanfacine hcl er 4 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover Guanfacine hcl er 4 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
guanidine hcl 125 mg tablet ![Compare how all Medicare Part D PDP plans in NY cover guanidine hcl 125 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | N/A | None |