
	PREFERRED DRUG LIST

This program is designed to educate you on the use of generic and other low cost brand name drugs. This program is designed to help you find drugs within the same therapeutic class as a drug you may currently be taking. Most of all, this program is designed to save you money on your prescription drug costs.

Tiers indicate retail pharmacy pricing and position. Drug quantities listed must be adhered to in order to receive tier pricing at participating retail network pharmacies. Any change in quantity may result in higher prices. Company cannot be responsible for changes in network pharmacies which accept this program. A mail order option is available for additional savings based upon a three month supply. Mail order tiers will vary due to differing quantities.

Drug pricing is based on the quantity indicated by the retail and mail order columns. This may or may not be a 30 day supply based on how your Doctor prescribed your dosage. Quantities greater than those listed will result in a higher member cost.

* By law, schedule II drugs are only allowed to be dispensed for a 30 day supply through the mail order pharmacy.
* Pricing is subject to change without notice.

Search Results for Keyword: g

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
Gabapentin Cap 100 MG 30 $4.98 $19.17
Gabapentin Cap 400 MG 30 $6.49 $57.50
Gentamicin Sulfate Cream 0.1% 15 $4.28 $4.46
Gentamicin Sulfate Oint 0.1% 30 $5.60 $9.60
Gentamicin Sulfate Ophth Soln 0.3% 5 $5.92 $8.82
Gentamicin Sulfate Ophth Soln 0.3% 5 $5.92 $21.90
Gentamicin Sulfate Ophth Soln 0.3% 1 $3.58 $4.74
Glimepiride Tab 1 MG 30 $5.76 $14.48
Glimepiride Tab 2 MG 30 $6.76 $23.47
Glimepiride Tab 4 MG 30 $6.56 $44.27
Glipizide Tab 10 MG 30 $5.83 $21.08
Glipizide Tab 5 MG 30 $5.04 $13.86
Glipizide Tab SR 24HR 2.5 MG 30 $9.33 $14.64
Glipizide Tab SR 24HR 2.5 MG 30 $9.33 $14.64
Glipizide Tab SR 24HR 5 MG 30 $8.31 $14.66
Glipizide Tab SR 24HR 5 MG 30 $8.31 $14.66
GLUCOSOURCE MIS LANCETS 100 $7.07 $11.63
GLUTARALDEHY SOL 25% 1 $2.85 $0.26
Glyburide Micronized Tab 1.5 MG 30 $4.56 $13.60
Glyburide Micronized Tab 1.5 MG 30 $4.56 $16.29
Glyburide Micronized Tab 3 MG 30 $5.10 $22.99
Glyburide Micronized Tab 3 MG 30 $5.10 $27.67
Glyburide Micronized Tab 6 MG 30 $5.47 $38.63
Glyburide Micronized Tab 6 MG 30 $5.47 $43.73
Glyburide Tab 1.25 MG 30 $6.50 $9.92
Glyburide Tab 2.5 MG 30 $6.06 $16.53
Glyburide Tab 5 MG 30 $8.75 $27.97
Glyburide-Metformin Tab 1.25-250 MG 30 $7.32 $31.90
Glyburide-Metformin Tab 2.5-500 MG 30 $7.33 $37.72
Glyburide-Metformin Tab 5-500 MG 30 $7.33 $37.72
GLYCOLIC ACD SOL 70% 1 $2.95 $0.54
Guaifenesin Tab 200 MG 30 $4.62 $11.34
Guaifenesin Tab 200 MG 30 $4.62 $33.67
Guaifenesin Tab 400 MG 30 $8.23 $8.37
Guaifenesin Tab CR 600 MG 30 $6.30 $9.07
Guaifenesin Tab CR 600 MG 30 $6.30 $10.01
Guanfacine HCl Tab 1 MG 30 $6.91 $36.63
Guanfacine HCl Tab 2 MG 30 $8.66 $49.77
GUANIDINE TAB 125MG 30 $9.64 $18.52

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
Gabapentin Cap 300 MG 30 $13.89 $47.92
Gabapentin Tab 100 MG 30 $14.91 $19.06
GABARONE TAB 100MG 30 $18.19 $41.52
GASTRINEX CAP 30 $17.78 $40.44
GEL-KAM CON 0.63% 283 $17.85 $40.62
Gemfibrozil Tab 600 MG 30 $10.95 $87.52
GENECOF-HC LIQ 473 $13.19 $28.08 *
GENELAN LIQ 473 $17.89 $40.73
GENELAN NF LIQ 473 $17.89 $40.73
GENEVIT-FA SYP 473 $11.21 $22.75
GENTAK OIN 0.3% OP 4 $19.86 $46.03
Gentamicin Sulfate Ophth Oint 0.3% 4 $17.70 $30.00
GENTLE-LET MIS 26G 200 $10.87 $21.83
GENTLE-LET MIS 28G 200 $10.87 $21.83
GENTLE-LET MIS LANCETS 200 $10.87 $21.83
GEREF INJ 0.5MG 1 $17.20 $38.87
GFN550/PSE60 TAB 30 $18.02 $41.08
GILTUSS LIQ PED-C 60 $14.30 $31.05 *
GILTUSS PED LIQ 60 $19.54 $45.16
Glipizide Tab SR 24HR 10 MG 30 $14.17 $29.02
Glipizide Tab SR 24HR 10 MG 30 $14.17 $29.02
Glycopyrrolate Inj 0.2 MG/ML 25 $18.98 $25.56
GNP LANCETS MIS 200 $10.57 $21.04
GNP LANCETS MIS COLOR 200 $11.26 $22.88
GNP LANCETS MIS THIN 200 $10.57 $21.04
GOLYTELY SOL 1 $14.04 $30.38
GONIOSOL SOL OP 15 $18.54 $42.47
GORDOCHOM SOL 6 $11.75 $24.22
GORDOFILM SOL 15 $12.02 $24.92
GRANULEX AER 57 $15.93 $35.45
GUACOL DM DRO PED 30 $15.88 $35.31
Guaifenesin Tab 400 MG 30 $11.22 $13.15
Guaifenesin Tab SR 12HR 1200 MG 30 $11.62 $13.80
Guaifenesin Tab SR 12HR 1200 MG 30 $15.23 $19.56
GYNODIOL TAB 1.5MG 30 $15.87 $35.28

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
Gabapentin Tab 300 MG 30 $32.78 $47.65
Gabapentin Tab 400 MG 30 $38.73 $57.18
Gabapentin Tab 600 MG 30 $27.60 $91.67
Gabapentin Tab 800 MG 30 $39.60 $109.85
GABARONE TAB 300MG 30 $41.35 $103.82
GABARONE TAB 400MG 30 $49.05 $124.53
GALZIN CAP 25MG 30 $28.97 $70.51
GALZIN CAP 50MG 30 $46.44 $117.52
GANTRIS PED SUS 500/5ML 473 $48.59 $123.30
GELFOAM MIS DENTAL 4 12 $45.71 $115.55
GENEPATUSS SYP 473 $26.55 $64.03
Gentamicin Sulfate Inj 40 MG/ML 50 $49.35 $74.16
GENTEX 30 LIQ 120 $35.29 $87.52
GENTEX LA TAB 30 $32.11 $78.97
GENTRAN/TRAV INJ 6-10% 500 $22.86 $54.08
GEREF INJ 1MG 1 $27.66 $66.99
GFN1000/DM50 TAB 30 $22.75 $53.79
GFN550/PSE60 TAB /DM 30 30 $20.12 $46.72
GIANT EAGLE TES 50 $25.47 $61.12
GILPHEX TR TAB 10-388MG 30 $25.70 $61.73
GILPHEX TR TAB 12HR 30 $23.86 $56.77
GILTUSS LIQ 237 $21.28 $49.84
GILTUSS TR TAB 30 $26.34 $63.46
Glipizide-Metformin HCl Tab 2.5-250 MG 30 $21.65 $29.84
Glipizide-Metformin HCl Tab 2.5-500 MG 30 $21.26 $35.60
Glipizide-Metformin HCl Tab 5-500 MG 30 $24.90 $35.60
GLUCO DEX TES SENSORS 50 $42.47 $106.82
GLUCO ELITE TES 50 $41.38 $103.90
GLUCOCOM TES 50 $41.90 $105.30
GLUCOFILM TES 25 $22.59 $53.35
GLUCOMETER TES ENCORE 50 $38.64 $96.53
GLUCOPHAGE TAB 500MG 30 $33.14 $81.73
GLUCOPHAGE TAB XR 500MG 30 $33.77 $83.43
GLUCOPHAGE TAB XR 750MG 30 $49.28 $125.15
GLUCOSTIX TES 25 $24.94 $59.67
GLUCOTROL TAB 10MG 30 $36.32 $90.28
GLUCOTROL TAB 5MG 30 $21.04 $49.18
GLUCOTROL XL TAB 10MG 30 $39.95 $100.04
GLUCOTROL XL TAB 2.5MG 30 $21.51 $50.45
GLUCOTROL XL TAB 5MG 30 $21.52 $50.49
GLUCOVANCE TAB 1.25/250 30 $36.25 $90.10
GLUCOVANCE TAB 2.5/500 30 $42.71 $107.48
GLUCOVANCE TAB 5/500MG 30 $42.71 $107.48
GLUTOFAC ZX TAB 30 $21.16 $49.51
GLUTOFAC-MX TAB 30 $38.40 $95.89
Glycopyrrolate Tab 1 MG 30 $21.19 $47.26
Glycopyrrolate Tab 2 MG 30 $41.16 $79.19
GLYCRON TAB 4.5MG 30 $28.46 $69.15
GLYCYRRHIZA LIQ NF 500 $20.37 $47.39
GLYNASE TAB 1.5MG 30 $22.21 $52.34
GLYNASE TAB 3MG 30 $37.58 $93.68
GLYSET TAB 100MG 30 $41.66 $104.66
GLYSET TAB 25MG 30 $32.75 $80.68
GLYSET TAB 50MG 30 $35.73 $88.72
GNP TEST MIS 100 $33.63 $83.05
GOLYTELY SOL PINEAPPL 4000 $24.99 $59.76
GONAL-F INJ 1 $45.99 $116.30
GORDONS UREA OIN 40% 30 $49.51 $125.78
Granisetron HCl Inj 0.1 MG/ML 5 $30.00 $43.20
Griseofulvin Microsize Susp 125 MG/5ML 120 $34.30 $50.08
Guaifenesin Liquid 100 MG/5ML 473 $42.00 $62.41
Guaifenesin-Codeine Soln 100-6.3 MG/5ML 473 $22.45 $31.13 *
Guaifenesin-Pot Guaiacolsulfonate Tab SR 12HR 600-300 MG 30 $22.82 $31.71
GUANABENZ TAB 4MG 30 $30.76 $75.32

Drug Name Retail Qty Retail Mail Order
(3 x Retail Qty)
GABADONE TAB
$87.27
$227.33

GABITRIL TAB 12MG
$173.38
$458.93

GABITRIL TAB 16MG
$226.56
$601.97

GABITRIL TAB 2MG
$134.88
$355.39

GABITRIL TAB 4MG
$134.88
$355.39

Galantamine Hydrobromide Tab 12 MG
$57.20
$114.56

Galantamine Hydrobromide Tab 4 MG
$57.20
$114.56

Galantamine Hydrobromide Tab 8 MG
$57.20
$114.56

Ganciclovir Cap 250 MG
$109.20
$169.93

Ganciclovir Cap 500 MG
$215.41
$339.85

GANIRELIX AC INJ
$114.38
$300.26

GANITE INJ 25MG/ML
$1090.25
$2925.00

GARAMYCIN INJ 40MG/ML
$146.79
$387.41

GARDASIL INJ
$144.55
$381.40

GASTROCROM CON 100/5ML
$236.69
$629.21

GASTROGRAFIN SOL
$829.50
$2223.68

GASTROMARK SUS 175MCG
$345.33
$921.46

GELCLAIR GEL
$62.13
$159.71

GELFILM MIS ENVELOPE
$634.46
$1699.09

GELFILM MIS OP
$218.28
$579.69

GELFOAM MIS 6 CM
$695.27
$1862.64

GELFOAM MIS PROST 18
$696.71
$1866.50

GELFOAM MIS SPON COM
$274.02
$729.61

GELFOAM MIS SPONG 50
$123.98
$326.06

GELFOAM MIS SPONG100
$274.57
$731.09

GELFOAM MIS SPONG127
$100.75
$263.58

GELFOAM MIS SPONG200
$444.85
$1189.09

GEMZAR INJ 1 GM
$808.54
$2167.29

GEMZAR INJ 200MG
$163.92
$433.48

GENOTROPIN INJ 0.2MG
$98.20
$256.72

GENOTROPIN INJ 0.4MG
$193.65
$513.46

GENOTROPIN INJ 0.6MG
$289.09
$770.15

GENOTROPIN INJ 0.8MG
$384.55
$1026.92

GENOTROPIN INJ 1.2MG
$575.45
$1540.35

GENOTROPIN INJ 1.5MG
$362.43
$967.43

GENOTROPIN INJ 1.6MG
$766.34
$2053.79

GENOTROPIN INJ 1.8MG
$861.78
$2310.51

GENOTROPIN INJ 13.8MG
$3516.63
$9451.12

GENOTROPIN INJ 1MG
$480.00
$1283.64

GENOTROPIN INJ 2MG
$957.24
$2567.25

GENOTROPIN INJ 5.8MG
$242.53
$644.93

GENTAM/NACL INJ 100MG PB
$227.75
$605.20

GENTAM/NACL INJ 70MG PB
$98.02
$256.25

GENTAM/NACL INJ 90MG PB
$104.53
$273.82

Gentamicin in Saline Inj 0.8 MG/ML
$163.15
$256.25

Gentamicin in Saline Inj 1 MG/ML
$72.26
$310.32

Gentamicin in Saline Inj 1.2 MG/ML
$95.87
$148.61

Gentamicin in Saline Inj 1.6 MG/ML
$57.88
$87.80

Gentamicin Sulfate Inj 10 MG/ML
$96.52
$149.63

GENTEX HC LIQ
$107.14
$280.78

GEOCILLIN TAB 382MG
$83.01
$215.87

GEODON CAP 20MG
$197.85
$517.93

GEODON CAP 40MG
$197.85
$517.93

GEODON CAP 60MG
$239.51
$628.52

GEODON CAP 80MG
$239.51
$628.52

GEODON INJ 20MG
$149.77
$395.44

GEREF DIAG INJ 50MCG
$95.10
$248.39

GESTICARE TAB
$50.21
$127.66

GILTUSS HC LIQ
$95.30
$248.92

GINGER OIL FCC
$71.87
$185.91

GLEEVEC TAB 100MG
$1322.86
$3550.64

GLEEVEC TAB 400MG
$4759.59
$12794.27

GLIADEL WAF 7.7MG
$27526.29
$74028.83

GLIADEL WAF WAFER
$18917.94
$50875.34

GLOFIL-125 INJ 0.1%
$2253.88
$6054.75

GLUCAGEN INJ 1MG
$764.00
$2047.50

GLUCAGON KIT 1MG
$120.58
$316.93

GLUCOPHAGE TAB 1000MG
$65.35
$168.36

GLUCOPHAGE TAB 850MG
$54.41
$138.95

GLUCOPROTEIN TES
$58.43
$149.76

GLUCOWATCH G KIT BIOGRAPH
$761.83
$2041.65

GLUMETZA TAB 1000MG
$124.84
$328.37

GLUMETZA TAB 500MG
$53.84
$137.40

GLUTOFAC-ZX TAB
$51.95
$132.34

GLYCEROLIZIN SOL
$132.73
$349.63

Glycine Irrigation Soln 1.5%
$171.72
$270.00

Glyc-Sod Lact-Sod Phos-Sod Biphos-Pot Cl In Vitro Soln
$73.51
$112.75

GLYNASE TAB 6MG
$62.37
$160.36

GLYQUIN XM CRE
$68.43
$176.65

Gold Sodium Thiomalate Inj 50 MG/ML
$134.25
$210.00

GONAL-F INJ 1050UNIT
$1493.13
$4008.60

GONAL-F INJ 1200IU
$1065.24
$2857.73

GONAL-F INJ 150IU
$149.35
$394.29

GONAL-F INJ 450IU
$641.49
$1717.99

GONAL-F INJ 75IU
$78.88
$204.75

GONAL-F RFF INJ 300
$428.57
$1145.31

GONAL-F RFF INJ 450
$641.49
$1717.99

GONAL-F RFF INJ 75IU
$109.21
$286.34

GONAL-F RFF INJ 900
$1280.22
$3435.95

Granisetron HCl Inj 1 MG/ML
$160.50
$252.00

Granisetron HCl Oral Soln 2 MG/10ML (Base Equivalent)
$283.31
$448.49

Granisetron HCl Tab 1 MG
$1330.95
$2124.72

GRIFULVIN V SUS 125/5ML
$68.68
$177.33

GRIFULVIN V TAB MICR 500
$130.11
$342.57

GRIS-PEG TAB 125MG
$61.48
$157.95

GRIS-PEG TAB 250MG
$77.79
$201.83

GUAIACOL SOL PURIFIED
$77.35
$200.66

GUAIFED CAP 15-400MG
$70.93
$183.39

GUAIFED-PD CAP 7.5-200
$69.44
$179.36

GUANABENZ TAB 8MG
$57.21
$146.49

GYNAZOLE-1 CRE 2%
$57.19
$146.41

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