2018 Medicare Part D Plan Formulary Information |
Community Blue Medicare PPO Signature (PPO) (H3916-035-2)
Benefit Details
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The Community Blue Medicare PPO Signature (PPO) (H3916-035-2) Formulary Drugs Starting with the Letter G in Venango County, PA: CMS MA Region 6 which includes: PA Plan Monthly Premium: $27.00 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 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GABAPENTIN 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Gabapentin 250mg/5mL 470 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GABAPENTIN 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GABAPENTIN 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GABAPENTIN 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GABAPENTIN 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GABAPENTIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GABAPENTIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GABAPENTIN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GABAPENTIN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GALANTAMINE 4 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE 4 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GALANTAMINE ER 16 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE ER 16 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GALANTAMINE ER 24 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE ER 24 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GALANTAMINE ER 8 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE ER 8 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GALANTAMINE HBR 12 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE HBR 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GALANTAMINE HBR 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE HBR 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GALANTAMINE HBR 8 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GALANTAMINE HBR 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GAMASTAN ASD S/D VL 2 ML ![Compare how all Medicare Part D PDP plans in PA cover GAMASTAN ASD S/D VL 2 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
GAMASTAN S-D 10 ML ![Compare how all Medicare Part D PDP plans in PA cover GAMASTAN S-D 10 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in PA cover GAMMAGARD LIQUID 10% VIAL.](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 PA 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 PA 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 PA 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 PA 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 PA 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 PA 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 PA 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 PA 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 PA cover GANCICLOVIR 500MG VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GARDASIL 9 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover GARDASIL 9 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
GARDASIL 9 VIAL ![Compare how all Medicare Part D PDP plans in PA cover GARDASIL 9 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid] ![Compare how all Medicare Part D PDP plans in PA cover GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GATTEX 5 MG 30-VIAL KIT ![Compare how all Medicare Part D PDP plans in PA cover GATTEX 5 MG 30-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 PA cover GAVILYTE-C SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GAVILYTE-G SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover GAVILYTE-G SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GAVILYTE-N SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover GAVILYTE-N SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GEMCITABINE HCL 1 GRAM VIAL ![Compare how all Medicare Part D PDP plans in PA cover GEMCITABINE HCL 1 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GEMFIBROZIL 600 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GEMFIBROZIL 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GENERLAC 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover GENERLAC 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GENGRAF 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GENGRAF 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in PA cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GENGRAF 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GENGRAF 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GENOTROPIN 13.8MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA 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 PA cover GENOTROPIN 5 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
GENOTROPIN MINIQUICK 0.2MG ![Compare how all Medicare Part D PDP plans in PA cover GENOTROPIN MINIQUICK 0.2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
GENOTROPIN MINIQUICK 0.4MG ![Compare how all Medicare Part D PDP plans in PA 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 PA cover GENOTROPIN MINIQUICK 0.6MG.](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 0.8MG ![Compare how all Medicare Part D PDP plans in PA 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 PA 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 PA 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 PA 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 PA cover GENOTROPIN MINIQUICK 1.8MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GENOTROPIN MINIQUICK 1MG ![Compare how all Medicare Part D PDP plans in PA 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 PA 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 PA cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GENTAMICIN 3 MG/ML EYE DROPS ![Compare how all Medicare Part D PDP plans in PA cover GENTAMICIN 3 MG/ML EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | 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 PA 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) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in PA 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 |
$15.00 | $40.00 | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in PA cover GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GENVOYA TABLET ![Compare how all Medicare Part D PDP plans in PA cover GENVOYA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
GEODON 20MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GILENYA 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GILENYA 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:31 /31Days |
GILOTRIF 20 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GILOTRIF 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:31 /31Days |
GILOTRIF 30 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GILOTRIF 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:31 /31Days |
GILOTRIF 40 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GILOTRIF 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:31 /31Days |
GLATIRAMER 20 MG/ML SYRINGE [Copaxone] ![Compare how all Medicare Part D PDP plans in PA cover GLATIRAMER 20 MG/ML SYRINGE [Copaxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:31 /31Days |
GLATIRAMER 40 MG/ML SYRINGE [Copaxone] ![Compare how all Medicare Part D PDP plans in PA cover GLATIRAMER 40 MG/ML SYRINGE [Copaxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:12 /28Days |
Glatopa 20 mg/ml syringe ![Compare how all Medicare Part D PDP plans in PA cover Glatopa 20 mg/ml syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLATOPA 40 MG/ML SYRINGE [Glatopa] ![Compare how all Medicare Part D PDP plans in PA cover GLATOPA 40 MG/ML SYRINGE [Glatopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:12 /28Days |
GLEOSTINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GLEOSTINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GLEOSTINE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GLEOSTINE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GLEOSTINE 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover GLEOSTINE 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GLIMEPIRIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIMEPIRIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIMEPIRIDE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIMEPIRIDE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIMEPIRIDE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIMEPIRIDE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE 5MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE ER 10 MG TABLET ER 24 [Glucotrol XL] ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE ER 10 MG TABLET ER 24 [Glucotrol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
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 ![Compare how all Medicare Part D PDP plans in PA 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 | $0.00 | None |
GLIPIZIDE-METFORMIN 2.5-250 MG ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE-METFORMIN 2.5-250 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLIPIZIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in PA cover GLIPIZIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in PA cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in PA cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
Glucose 50 MG/ML / Potassium Chloride 0.01 MEQ/ML / Sodium Chloride 0.0769 MEQ/ML Injectable Solutio ![Compare how all Medicare Part D PDP plans in PA cover Glucose 50 MG/ML / Potassium Chloride 0.01 MEQ/ML / Sodium Chloride 0.0769 MEQ/ML Injectable Solutio.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
Glucose 50 MG/ML / Potassium Chloride 0.02 MEQ/ML / Sodium Chloride 0.154 MEQ/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in PA cover Glucose 50 MG/ML / Potassium Chloride 0.02 MEQ/ML / Sodium Chloride 0.154 MEQ/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
Glucose 50 MG/ML / Potassium Chloride 0.04 MEQ/ML / Sodium Chloride 0.0769 MEQ/ML Injectable Solutio ![Compare how all Medicare Part D PDP plans in PA cover Glucose 50 MG/ML / Potassium Chloride 0.04 MEQ/ML / Sodium Chloride 0.0769 MEQ/ML Injectable Solutio.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GLYBURID-METFORMIN 1.25-250 MG [Glucovance] ![Compare how all Medicare Part D PDP plans in PA cover GLYBURID-METFORMIN 1.25-250 MG [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE 1.25MG TABLETS ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE 1.25MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE MICRO 1.5 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE MICRO 1.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE MICRO 6 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE MICRO 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE-METFORMIN 2.5-500 MG ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE-METFORMIN 2.5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYBURIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in PA cover GLYBURIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | P |
GLYCOPYRROLATE 4 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover GLYCOPYRROLATE 4 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GLYXAMBI 10 MG-5 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GLYXAMBI 10 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | Q:31 /31Days |
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 PA cover GLYXAMBI 25 MG-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | Q:31 /31Days |
GOLYTELY PACKET 227.1 GM/2.82 GM ![Compare how all Medicare Part D PDP plans in PA cover GOLYTELY PACKET 227.1 GM/2.82 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GONITRO 0.4 MG SUBLINGUAL PWD ![Compare how all Medicare Part D PDP plans in PA cover GONITRO 0.4 MG SUBLINGUAL PWD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
Granisetron 1 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in PA cover Granisetron 1 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
Granisetron HCl 0.1 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Granisetron HCl 0.1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
GRANISETRON HCL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover GRANISETRON HCL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | P |
Granisetron hcl 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in PA cover Granisetron hcl 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $115.00 | None |
GRANIX 300 MCG/0.5 ML SAFE SYR ![Compare how all Medicare Part D PDP plans in PA cover GRANIX 300 MCG/0.5 ML SAFE SYR.](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 PA 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 |
GRISEOFULVIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in PA cover GRISEOFULVIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GRISEOFULVIN MICRO 500 MG TAB ![Compare how all Medicare Part D PDP plans in PA cover GRISEOFULVIN MICRO 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg] ![Compare how all Medicare Part D PDP plans in PA cover GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg] ![Compare how all Medicare Part D PDP plans in PA cover GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |
Guanfacine hcl er 1 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Guanfacine hcl er 1 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
Guanfacine hcl er 2 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Guanfacine hcl er 2 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
Guanfacine hcl er 3 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Guanfacine hcl er 3 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
Guanfacine hcl er 4 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover Guanfacine hcl er 4 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | P |
guanidine hcl 125 mg tablet ![Compare how all Medicare Part D PDP plans in PA cover guanidine hcl 125 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $40.00 | None |
GYNAZOLE-1 2% CREAM ![Compare how all Medicare Part D PDP plans in PA cover GYNAZOLE-1 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$90.00 | $270.00 | None |