2018 Medicare Part D Plan Formulary Information |
Amerivantage Classic (HMO) (H7200-013-0)
Benefit Details
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The Amerivantage Classic (HMO) (H7200-013-0) Formulary Drugs Starting with the Letter G in Moore County, TN: CMS MA Region 10 which includes: TN 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 TN cover GABAPENTIN 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | Q:1080 /30Days |
Gabapentin 250mg/5mL 470 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in TN cover Gabapentin 250mg/5mL 470 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:2160 /30Days |
GABAPENTIN 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GABAPENTIN 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | Q:360 /30Days |
GABAPENTIN 400 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GABAPENTIN 400 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | Q:270 /30Days |
GABAPENTIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GABAPENTIN 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:180 /30Days |
GABAPENTIN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GABAPENTIN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
GABITRIL 12 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GABITRIL 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GABITRIL 16mg/1 ![Compare how all Medicare Part D PDP plans in TN cover GABITRIL 16mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
GALANTAMINE 4 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE 4 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:180 /30Days |
GALANTAMINE ER 16 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE ER 16 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GALANTAMINE ER 24 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE ER 24 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:30 /30Days |
GALANTAMINE ER 8 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE ER 8 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:30 /30Days |
GALANTAMINE HBR 12 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE HBR 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
GALANTAMINE HBR 4 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE HBR 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
GALANTAMINE HBR 8 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GALANTAMINE HBR 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
Gamunex-C 10g/100mL 10 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in TN 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 TN cover GANCICLOVIR 500MG VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
GARDASIL 9 SYRINGE ![Compare how all Medicare Part D PDP plans in TN cover GARDASIL 9 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GARDASIL 9 VIAL ![Compare how all Medicare Part D PDP plans in TN cover GARDASIL 9 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid] ![Compare how all Medicare Part D PDP plans in TN cover GATIFLOXACIN 0.5% EYE DROPS [Zymar, Zymaxid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GATTEX 5 MG 30-VIAL KIT ![Compare how all Medicare Part D PDP plans in TN 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 |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GAVILYTE-C SOLUTION ![Compare how all Medicare Part D PDP plans in TN cover GAVILYTE-C SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GAVILYTE-G SOLUTION ![Compare how all Medicare Part D PDP plans in TN cover GAVILYTE-G SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GAVILYTE-N SOLUTION ![Compare how all Medicare Part D PDP plans in TN cover GAVILYTE-N SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GEMCITABINE HCL 1 GRAM VIAL ![Compare how all Medicare Part D PDP plans in TN cover GEMCITABINE HCL 1 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
GEMFIBROZIL 600 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GEMFIBROZIL 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GENERLAC 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in TN cover GENERLAC 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GENGRAF 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GENGRAF 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GENGRAF 100MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in TN cover GENGRAF 100MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GENGRAF 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GENGRAF 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GENTAK 3MG/GM EYE OINTMENT ![Compare how all Medicare Part D PDP plans in TN cover GENTAK 3MG/GM EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
GENTAMICIN 3 MG/ML EYE DROPS ![Compare how all Medicare Part D PDP plans in TN cover GENTAMICIN 3 MG/ML EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 TN 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) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GENTAMICIN SULFATE CREAM USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in TN 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 | N/A | None |
Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in TN cover Gentamicin Sulfate in Sodium Chloride 60mg/50mL 50 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GENTAMICIN SULFATE OINTMENT USP 0.1% 15GM TUBE ![Compare how all Medicare Part D PDP plans in TN 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 | N/A | None |
GENVOYA TABLET ![Compare how all Medicare Part D PDP plans in TN 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 TN cover GEODON 20MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:6 /28Days |
GIANVI 3 MG-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GIANVI 3 MG-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GILENYA 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN 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:30 /30Days |
GILOTRIF 20 MG TABLET ![Compare how all Medicare Part D PDP plans in TN 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 TN 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 TN 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 |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLATIRAMER 20 MG/ML SYRINGE [Copaxone] ![Compare how all Medicare Part D PDP plans in TN cover GLATIRAMER 20 MG/ML SYRINGE [Copaxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
GLATIRAMER 40 MG/ML SYRINGE [Copaxone] ![Compare how all Medicare Part D PDP plans in TN cover GLATIRAMER 40 MG/ML SYRINGE [Copaxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:12 /28Days |
Glatopa 20 mg/ml syringe ![Compare how all Medicare Part D PDP plans in TN cover Glatopa 20 mg/ml syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
GLATOPA 40 MG/ML SYRINGE [Glatopa] ![Compare how all Medicare Part D PDP plans in TN cover GLATOPA 40 MG/ML SYRINGE [Glatopa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:12 /28Days |
GLEEVEC 100MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in TN 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:240 /30Days |
GLEEVEC 400 MG TABLET ![Compare how all Medicare Part D PDP plans in TN 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 |
GLEOSTINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GLEOSTINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GLEOSTINE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GLEOSTINE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GLEOSTINE 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in TN cover GLEOSTINE 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
GLIMEPIRIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIMEPIRIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:240 /30Days |
GLIMEPIRIDE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIMEPIRIDE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLIMEPIRIDE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIMEPIRIDE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:60 /30Days |
GLIPIZIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:120 /30Days |
GLIPIZIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:240 /30Days |
GLIPIZIDE 5MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE 5MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:120 /30Days |
GLIPIZIDE ER 10 MG TABLET ER 24 [Glucotrol XL] ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE ER 10 MG TABLET ER 24 [Glucotrol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:60 /30Days |
GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE ER 2.5MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:240 /30Days |
GLIPIZIDE-METFORMIN 2.5-250 MG ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE-METFORMIN 2.5-250 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:240 /30Days |
GLIPIZIDE-METFORMIN 2.5-500MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE-METFORMIN 2.5-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:120 /30Days |
GLIPIZIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in TN cover GLIPIZIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Select Care Drugs |
$0.00 | N/A | Q:120 /30Days |
GLUCAGEN 1MG HYPOKIT ![Compare how all Medicare Part D PDP plans in TN cover GLUCAGEN 1MG HYPOKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GLUCAGON 1MG EMERGENCY KIT ![Compare how all Medicare Part D PDP plans in TN cover GLUCAGON 1MG EMERGENCY KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUCOPHAGE 1000MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOPHAGE 1000MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
GLUCOPHAGE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOPHAGE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:150 /30Days |
GLUCOPHAGE 850MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOPHAGE 850MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:90 /30Days |
GLUCOPHAGE XR 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in TN cover GLUCOPHAGE XR 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
GLUCOPHAGE XR 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in TN cover GLUCOPHAGE XR 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
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 TN 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 |
$95.00 | N/A | 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 TN 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 |
$95.00 | N/A | 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 TN 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 |
$95.00 | N/A | None |
GLUCOTROL 10MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOTROL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
GLUCOTROL 5MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOTROL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:240 /30Days |
GLUCOTROL XL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOTROL XL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLUCOTROL XL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOTROL XL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:240 /30Days |
GLUCOTROL XL 5 MG TABLET ER 24 ![Compare how all Medicare Part D PDP plans in TN cover GLUCOTROL XL 5 MG TABLET ER 24.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
GLUCOVANCE 2.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOVANCE 2.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:120 /30Days |
GLUCOVANCE 5/500MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUCOVANCE 5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:120 /30Days |
GLUMETZA ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLUMETZA ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:60 /30Days |
GLUMETZA ER 500 MG TABLET TABERGR24H ![Compare how all Medicare Part D PDP plans in TN cover GLUMETZA ER 500 MG TABLET TABERGR24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:120 /30Days |
GLYBURID-METFORMIN 1.25-250 MG [Glucovance] ![Compare how all Medicare Part D PDP plans in TN cover GLYBURID-METFORMIN 1.25-250 MG [Glucovance].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:240 /30Days |
GLYBURIDE 1.25MG TABLETS ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE 1.25MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:480 /30Days |
GLYBURIDE 2.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE 2.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:240 /30Days |
GLYBURIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:120 /30Days |
GLYBURIDE MICRO 1.5 MG TAB ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE MICRO 1.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
GLYBURIDE MICRO 3MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE MICRO 3MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:120 /30Days |
GLYBURIDE MICRO 6 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE MICRO 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:60 /30Days |
GLYBURIDE-METFORMIN 2.5-500 MG ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE-METFORMIN 2.5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:120 /30Days |
GLYBURIDE-METFORMIN 5-500 MG ![Compare how all Medicare Part D PDP plans in TN cover GLYBURIDE-METFORMIN 5-500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P Q:120 /30Days |
GLYCOPYRROLATE 4 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in TN cover GLYCOPYRROLATE 4 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GLYCOPYRROLATE TABLET 1MG (100 CT) ![Compare how all Medicare Part D PDP plans in TN cover GLYCOPYRROLATE TABLET 1MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GLYCOPYRROLATE TABLET 2MG (100 CT) ![Compare how all Medicare Part D PDP plans in TN cover GLYCOPYRROLATE TABLET 2MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
GLYSET 100MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLYSET 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:90 /30Days |
GLYSET 25MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLYSET 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:360 /30Days |
GLYSET 50MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GLYSET 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:180 /30Days |
Granisetron 1 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in TN cover Granisetron 1 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Granisetron HCl 0.1 mg/ml vial ![Compare how all Medicare Part D PDP plans in TN cover Granisetron HCl 0.1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRANISETRON HCL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GRANISETRON HCL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:30 /30Days |
Granisetron hcl 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in TN cover Granisetron hcl 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRIS-PEG 250 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GRIS-PEG 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRISEOFULVIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in TN cover GRISEOFULVIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRISEOFULVIN MICRO 500 MG TAB ![Compare how all Medicare Part D PDP plans in TN cover GRISEOFULVIN MICRO 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg] ![Compare how all Medicare Part D PDP plans in TN cover GRISEOFULVIN ULTRA 125 MG TABLET [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg] ![Compare how all Medicare Part D PDP plans in TN cover GRISEOFULVIN ULTRA 250 MG Tablet [Gris-Peg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
GUANFACINE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GUANFACINE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P |
GUANFACINE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in TN cover GUANFACINE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | N/A | P |
Guanfacine hcl er 1 mg tablet ![Compare how all Medicare Part D PDP plans in TN cover Guanfacine hcl er 1 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Guanfacine hcl er 2 mg tablet ![Compare how all Medicare Part D PDP plans in TN cover Guanfacine hcl er 2 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:30 /30Days |
Guanfacine hcl er 3 mg tablet ![Compare how all Medicare Part D PDP plans in TN cover Guanfacine hcl er 3 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:30 /30Days |
Guanfacine hcl er 4 mg tablet ![Compare how all Medicare Part D PDP plans in TN cover Guanfacine hcl er 4 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:30 /30Days |
guanidine hcl 125 mg tablet ![Compare how all Medicare Part D PDP plans in TN cover guanidine hcl 125 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |