2018 Medicare Part D Plan Formulary Information |
Aetna Medicare Value Plan (PPO) (H5521-077-0)
Benefit Details
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The Aetna Medicare Value Plan (PPO) (H5521-077-0) Formulary Drugs Starting with the Letter G in Oswego County, NY: CMS MA Region 3 which includes: NY Plan Monthly Premium: $0.00 Deductible: $100 |
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 NY cover GABAPENTIN 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
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) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:2160 /30Days |
GABAPENTIN 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
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) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:270 /30Days |
GABAPENTIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:180 /30Days |
GABAPENTIN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GABAPENTIN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | Q:120 /30Days |
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 | $300.00 | 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 | $300.00 | None |
GABITRIL 2mg/1 ![Compare how all Medicare Part D PDP plans in NY cover GABITRIL 2mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GABITRIL 4mg/1 ![Compare how all Medicare Part D PDP plans in NY cover GABITRIL 4mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GALANTAMINE 4 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE 4 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:200 /30Days |
GALANTAMINE ER 16 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE ER 16 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
GALANTAMINE ER 24 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE ER 24 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
GALANTAMINE HBR 12 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE HBR 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
GALANTAMINE HBR 4 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE HBR 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
GALANTAMINE HBR 8 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GALANTAMINE HBR 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
GAMASTAN ASD S/D VL 2 ML ![Compare how all Medicare Part D PDP plans in NY cover GAMASTAN ASD S/D VL 2 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
GAMASTAN S-D 10 ML ![Compare how all Medicare Part D PDP plans in NY cover GAMASTAN S-D 10 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P |
GAMMAGARD LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in NY cover GAMMAGARD LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 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 |
31% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | N/A | P |
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 |
31% | 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 |
31% | 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 |
31% | 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 |
$42.00 | $121.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GATTEX 5 MG 30-VIAL KIT ![Compare how all Medicare Part D PDP plans in NY cover GATTEX 5 MG 30-VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 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 |
$5.00 | $10.00 | 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 |
$5.00 | $10.00 | 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 |
$5.00 | $10.00 | 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 | $300.00 | Q:30 /30Days |
GEMCITABINE HCL 1 GRAM VIAL ![Compare how all Medicare Part D PDP plans in NY cover GEMCITABINE HCL 1 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GEMFIBROZIL 600 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GEMFIBROZIL 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | 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 |
$5.00 | $10.00 | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 |
31% | 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 |
31% | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
31% | 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 |
$5.00 | $10.00 | None |
GENTAMICIN 3 MG/ML EYE DROPS ![Compare how all Medicare Part D PDP plans in NY cover GENTAMICIN 3 MG/ML EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | 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 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 |
31% | N/A | None |
GEODON 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GEODON 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /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 | $300.00 | Q:6 /3Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GEODON 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GEODON 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
GEODON 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GEODON 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
GEODON 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in NY cover GEODON 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:60 /30Days |
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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 |
31% | 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 |
31% | N/A | P Q:28 /28Days |
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 |
31% | N/A | P |
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 |
31% | N/A | P |
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 |
31% | N/A | P |
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 |
31% | N/A | P Q:90 /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 |
31% | 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 | $300.00 | 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 | $300.00 | 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 | $300.00 | None |
GLIMEPIRIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in NY 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 NY 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 NY 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 NY 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 NY 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 NY 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 NY 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 |
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 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLIPIZIDE-METFORMIN 2.5-250 MG ![Compare how all Medicare Part D PDP plans in NY 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 NY 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 NY 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 NY cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 |
$42.00 | $121.00 | None |
GLUCOPHAGE 1000MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOPHAGE 1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOPHAGE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOPHAGE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOPHAGE 850MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOPHAGE 850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOPHAGE XR 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in NY cover GLUCOPHAGE XR 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOPHAGE XR 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in NY cover GLUCOPHAGE XR 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 NY 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 NY 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 NY 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOTROL 10MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOTROL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOTROL 5MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOTROL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOTROL XL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOTROL XL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOTROL XL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLUCOTROL XL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GLUCOTROL XL 5 MG TABLET ER 24 ![Compare how all Medicare Part D PDP plans in NY cover GLUCOTROL XL 5 MG TABLET ER 24.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 | $300.00 | P |
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 | $300.00 | P |
GLYBURID-METFORMIN 1.25-250 MG [Glucovance] ![Compare how all Medicare Part D PDP plans in NY cover GLYBURID-METFORMIN 1.25-250 MG [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
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) |
2* |
Generic |
$5.00 | $10.00 | 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 NY cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYBURIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYBURIDE MICRO 1.5 MG TAB ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE MICRO 1.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
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) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYBURIDE MICRO 6 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE MICRO 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYBURIDE-METFORMIN 2.5-500 MG ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE-METFORMIN 2.5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYBURIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in NY cover GLYBURIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | P |
GLYCOPYRROLATE 4 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in NY cover GLYCOPYRROLATE 4 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
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 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYNASE 3 MG PRESTAB ![Compare how all Medicare Part D PDP plans in NY cover GLYNASE 3 MG PRESTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
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 | $300.00 | P |
GOLYTELY PACKET 227.1 GM/2.82 GM ![Compare how all Medicare Part D PDP plans in NY cover GOLYTELY PACKET 227.1 GM/2.82 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | None |
GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM ![Compare how all Medicare Part D PDP plans in NY cover GOLYTELY SOLUTION 236 GM/2.97 GM/6 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | 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 | $300.00 | None |
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 | $300.00 | None |
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 | $300.00 | Q:156 /365Days |
GRANISETRON HCL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GRANISETRON HCL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $121.00 | P Q:60 /30Days |
GRANIX 300 MCG/0.5 ML SAFE SYR ![Compare how all Medicare Part D PDP plans in NY cover GRANIX 300 MCG/0.5 ML SAFE SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | N/A | P |
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 |
31% | 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GRISEOFULVIN MICRO 500 MG TAB ![Compare how all Medicare Part D PDP plans in NY cover GRISEOFULVIN MICRO 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg] ![Compare how all Medicare Part D PDP plans in NY cover GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg] ![Compare how all Medicare Part D PDP plans in NY cover GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
GUANFACINE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GUANFACINE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
GUANFACINE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in NY cover GUANFACINE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 |
$42.00 | $121.00 | P Q:30 /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 |
$42.00 | $121.00 | P Q:30 /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 |
$42.00 | $121.00 | P 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 |
$42.00 | $121.00 | P 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 | $300.00 | None |