Program Overview Preferred Drug List Pharmacy Network FAQ's
Pharmacy Network
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.
Drug quantities listed must be adhered to in order to receive Tier pricing. Any change in listed quantity may result in higher prices. Company cannot be responsible for changes in network pharmacies which accept this program.
Brand name drugs are signifed in UPPER case text. Generic drugs are signifed in Standard case text.
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First Tier
DRUG NAME (DOSE)QTY
Gabapentin Cap 100 MG30.00
Gabapentin Cap 400 MG30.00
Gentamicin Sulfate Cream 0.1%15.00
Gentamicin Sulfate Oint 0.1%30.00
Gentamicin Sulfate Ophth Soln 0.3%5.00
Gentamicin Sulfate Ophth Soln 0.3%5.00
Gentamicin Sulfate Ophth Soln 0.3%1.00
Glimepiride Tab 1 MG30.00
Glimepiride Tab 2 MG30.00
Glimepiride Tab 4 MG30.00
Glipizide Tab 10 MG30.00
Glipizide Tab 5 MG30.00
Glipizide Tab SR 24HR 2.5 MG30.00
Glipizide Tab SR 24HR 2.5 MG30.00
Glipizide Tab SR 24HR 5 MG30.00
Glipizide Tab SR 24HR 5 MG30.00
GLUCOSOURCE MIS LANCETS100.00
GLUTARALDEHY SOL 25%1.00
Glyburide Micronized Tab 1.5 MG30.00
Glyburide Micronized Tab 1.5 MG30.00
DRUG NAME (DOSE)QTY
Glyburide Micronized Tab 3 MG30.00
Glyburide Micronized Tab 3 MG30.00
Glyburide Micronized Tab 6 MG30.00
Glyburide Micronized Tab 6 MG30.00
Glyburide Tab 1.25 MG30.00
Glyburide Tab 2.5 MG30.00
Glyburide Tab 5 MG30.00
Glyburide-Metformin Tab 1.25-250 MG30.00
Glyburide-Metformin Tab 2.5-500 MG30.00
Glyburide-Metformin Tab 5-500 MG30.00
GLYCOLIC ACD SOL 70%1.00
Guaifenesin Tab 200 MG30.00
Guaifenesin Tab 200 MG30.00
Guaifenesin Tab 400 MG30.00
Guaifenesin Tab CR 600 MG30.00
Guaifenesin Tab CR 600 MG30.00
Guanfacine HCl Tab 1 MG30.00
Guanfacine HCl Tab 2 MG30.00
GUANIDINE TAB 125MG30.00
Second Tier
DRUG NAME (DOSE)QTY
Gabapentin Cap 300 MG30.00
Gabapentin Tab 100 MG30.00
GABARONE TAB 100MG30.00
GASTRINEX CAP30.00
GEL-KAM CON 0.63%283.00
Gemfibrozil Tab 600 MG30.00
GENECOF-HC LIQ473.00
GENELAN LIQ473.00
GENELAN NF LIQ473.00
GENEVIT-FA SYP473.00
GENTAK OIN 0.3% OP3.50
Gentamicin Sulfate Ophth Oint 0.3%3.50
GENTLE-LET MIS 26G200.00
GENTLE-LET MIS 28G200.00
GENTLE-LET MIS LANCETS200.00
GEREF INJ 0.5MG1.00
GFN550/PSE60 TAB30.00
GILTUSS LIQ PED-C60.00
DRUG NAME (DOSE)QTY
GILTUSS PED LIQ60.00
Glipizide Tab SR 24HR 10 MG30.00
Glipizide Tab SR 24HR 10 MG30.00
Glycopyrrolate Inj 0.2 MG/ML25.00
GNP LANCETS MIS200.00
GNP LANCETS MIS COLOR200.00
GNP LANCETS MIS THIN200.00
GOLYTELY SOL1.00
GONIOSOL SOL OP15.00
GORDOCHOM SOL6.00
GORDOFILM SOL15.00
GRANULEX AER56.70
GUACOL DM DRO PED30.00
Guaifenesin Tab 400 MG30.00
Guaifenesin Tab SR 12HR 1200 MG30.00
Guaifenesin Tab SR 12HR 1200 MG30.00
GYNODIOL TAB 1.5MG30.00

Third Tier

DRUG NAME (DOSE)QTY
Gabapentin Tab 300 MG30.00
Gabapentin Tab 400 MG30.00
Gabapentin Tab 600 MG30.00
Gabapentin Tab 800 MG30.00
GABARONE TAB 300MG30.00
GABARONE TAB 400MG30.00
GALZIN CAP 25MG30.00
GALZIN CAP 50MG30.00
GANTRIS PED SUS 500/5ML473.00
GELFOAM MIS DENTAL 412.00
GENEPATUSS SYP473.00
Gentamicin Sulfate Inj 40 MG/ML50.00
GENTEX 30 LIQ120.00
GENTEX LA TAB30.00
GENTRAN/TRAV INJ 6-10%500.00
GEREF INJ 1MG1.00
GFN1000/DM50 TAB30.00
GFN550/PSE60 TAB /DM 3030.00
GIANT EAGLE TES50.00
GILPHEX TR TAB 10-388MG30.00
GILPHEX TR TAB 12HR30.00
GILTUSS LIQ237.00
GILTUSS TR TAB30.00
Glipizide-Metformin HCl Tab 2.5-250 MG30.00
Glipizide-Metformin HCl Tab 2.5-500 MG30.00
Glipizide-Metformin HCl Tab 5-500 MG30.00
GLUCO DEX TES SENSORS50.00
GLUCO ELITE TES50.00
GLUCOCOM TES50.00
GLUCOFILM TES25.00
GLUCOMETER TES ENCORE50.00
GLUCOPHAGE TAB 500MG30.00
DRUG NAME (DOSE)QTY
GLUCOPHAGE TAB XR 500MG30.00
GLUCOPHAGE TAB XR 750MG30.00
GLUCOSTIX TES25.00
GLUCOTROL TAB 10MG30.00
GLUCOTROL TAB 5MG30.00
GLUCOTROL XL TAB 10MG30.00
GLUCOTROL XL TAB 2.5MG30.00
GLUCOTROL XL TAB 5MG30.00
GLUCOVANCE TAB 1.25/25030.00
GLUCOVANCE TAB 2.5/50030.00
GLUCOVANCE TAB 5/500MG30.00
GLUTOFAC ZX TAB30.00
GLUTOFAC-MX TAB30.00
Glycopyrrolate Tab 1 MG30.00
Glycopyrrolate Tab 2 MG30.00
GLYCRON TAB 4.5MG30.00
GLYCYRRHIZA LIQ NF500.00
GLYNASE TAB 1.5MG30.00
GLYNASE TAB 3MG30.00
GLYSET TAB 100MG30.00
GLYSET TAB 25MG30.00
GLYSET TAB 50MG30.00
GNP TEST MIS100.00
GOLYTELY SOL PINEAPPL4000.00
GONAL-F INJ1.00
GORDONS UREA OIN 40%30.00
Granisetron HCl Inj 0.1 MG/ML5.00
Griseofulvin Microsize Susp 125 MG/5ML120.00
Guaifenesin Liquid 100 MG/5ML473.00
Guaifenesin-Codeine Soln 100-6.3 MG/5ML473.00
Guaifenesin-Pot Guaiacolsulfonate Tab SR 12HR 600-300 MG30.00
GUANABENZ TAB 4MG30.00

Fourth Tier
DRUG NAME (DOSE)QTY
GABADONE TAB
GABITRIL TAB 12MG
GABITRIL TAB 16MG
GABITRIL TAB 2MG
GABITRIL TAB 4MG
Galantamine Hydrobromide Tab 12 MG
Galantamine Hydrobromide Tab 4 MG
Galantamine Hydrobromide Tab 8 MG
Ganciclovir Cap 250 MG
Ganciclovir Cap 500 MG
GANIRELIX AC INJ
GANITE INJ 25MG/ML
GARAMYCIN INJ 40MG/ML
GARDASIL INJ
GASTROCROM CON 100/5ML
GASTROGRAFIN SOL
GASTROMARK SUS 175MCG
GELCLAIR GEL
GELFILM MIS ENVELOPE
GELFILM MIS OP
GELFOAM MIS 6 CM
GELFOAM MIS PROST 18
GELFOAM MIS SPON COM
GELFOAM MIS SPONG 50
GELFOAM MIS SPONG100
GELFOAM MIS SPONG127
GELFOAM MIS SPONG200
GEMZAR INJ 1 GM
GEMZAR INJ 200MG
GENOTROPIN INJ 0.2MG
GENOTROPIN INJ 0.4MG
GENOTROPIN INJ 0.6MG
GENOTROPIN INJ 0.8MG
GENOTROPIN INJ 1.2MG
GENOTROPIN INJ 1.5MG
GENOTROPIN INJ 1.6MG
GENOTROPIN INJ 1.8MG
GENOTROPIN INJ 13.8MG
GENOTROPIN INJ 1MG
GENOTROPIN INJ 2MG
GENOTROPIN INJ 5.8MG
GENTAM/NACL INJ 100MG PB
GENTAM/NACL INJ 70MG PB
GENTAM/NACL INJ 90MG PB
Gentamicin in Saline Inj 0.8 MG/ML
Gentamicin in Saline Inj 1 MG/ML
Gentamicin in Saline Inj 1.2 MG/ML
Gentamicin in Saline Inj 1.6 MG/ML
Gentamicin Sulfate Inj 10 MG/ML
GENTEX HC LIQ
GEOCILLIN TAB 382MG
DRUG NAME (DOSE)QTY
GEODON CAP 20MG
GEODON CAP 40MG
GEODON CAP 60MG
GEODON CAP 80MG
GEODON INJ 20MG
GEREF DIAG INJ 50MCG
GESTICARE TAB
GILTUSS HC LIQ
GINGER OIL FCC
GLEEVEC TAB 100MG
GLEEVEC TAB 400MG
GLIADEL WAF 7.7MG
GLIADEL WAF WAFER
GLOFIL-125 INJ 0.1%
GLUCAGEN INJ 1MG
GLUCAGON KIT 1MG
GLUCOPHAGE TAB 1000MG
GLUCOPHAGE TAB 850MG
GLUCOPROTEIN TES
GLUCOWATCH G KIT BIOGRAPH
GLUMETZA TAB 1000MG
GLUMETZA TAB 500MG
GLUTOFAC-ZX TAB
GLYCEROLIZIN SOL
Glycine Irrigation Soln 1.5%
Glyc-Sod Lact-Sod Phos-Sod Biphos-Pot Cl In Vitro Soln
GLYNASE TAB 6MG
GLYQUIN XM CRE
Gold Sodium Thiomalate Inj 50 MG/ML
GONAL-F INJ 1050UNIT
GONAL-F INJ 1200IU
GONAL-F INJ 150IU
GONAL-F INJ 450IU
GONAL-F INJ 75IU
GONAL-F RFF INJ 300
GONAL-F RFF INJ 450
GONAL-F RFF INJ 75IU
GONAL-F RFF INJ 900
Granisetron HCl Inj 1 MG/ML
Granisetron HCl Oral Soln 2 MG/10ML (Base Equivalent)
Granisetron HCl Tab 1 MG
GRIFULVIN V SUS 125/5ML
GRIFULVIN V TAB MICR 500
GRIS-PEG TAB 125MG
GRIS-PEG TAB 250MG
GUAIACOL SOL PURIFIED
GUAIFED CAP 15-400MG
GUAIFED-PD CAP 7.5-200
GUANABENZ TAB 8MG
GYNAZOLE-1 CRE 2%
A B C D E
F G H I J
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 * Pricing is subject to change without notice.
 * Pricing is only for quantities stated, additional quantities may incur higher costs.
 * This is not an insured product.
 * Network pharmacies can be contracted at different rates resulting in some pricing differences.