G

PA = Prior Authorization is required; QL = Quantity limits apply; ST = Step Therapy applies;
RD = Specialty Formulary, please refer to Specialty Pharmacy Program section for additional information;
OTC = Over-the-counter Product, may be covered if a prescription is written, and it is filled at a retail or mailorder pharmacy

Medications written in all CAPITAL letters are Brand names.
Medications written in all lower case letters are available generically. The brand name is listed in parenthesis for reference only.


G
gabapentin (Neurontin)
GABITRIL
galantamine (Razadyne)
galantamine 24h caps (Razadyne ER)
ganciclovir (Cytovene)
GANTRISIN
gemfibrozil (Lopid)
gentamicin ointment/cream/opthalmic soln (Gentak)
GEODON capsules/inj
GLEEVEC, RD
glimepiride (Amaryl)
glipizide (Glucotrol)
glipizide ER (Glucotrol XL)
glipizide/metformin (Metaglip)
GLUCAGON
glyburide (Diabeta, Micronase)
glyburide, micronized (Glynase)
glyburide/metformin (Glucovance)
glycopyrrolate tabs (Robinul)
GLYSET
GOLYTELY packets
gonadotropin, chorionic (Novarel, Chorex, Pregnyl, Profasi), RD
granisetron tablets/oral solution (Kytril), QL
GRANULEX
griseofulvin susp (Grifulvin V)
GRIS-PEG
guaifenesin extended-release (Humibid L.A.)
guaifenesin/carbetapentane (Oratuss)
guaifenesin/codeine (Robitussin DAC)
guaifenesin/dextromethorphan/phenylephrine (Endacon-DM)
guaifenesin/dextromethorphan/pseudoephedrine (Maxifed DM)
guaifenesin/dyphylline (Difil-G)
guaifenesin/hydrocodone (Hycosin, Relasin-HCX)
guaifenesin/phenylephrine (Entex LA)
guaifenesin/pseudoephedrine (Duratuss)
guanfacine (Tenex)
GYNODIOL 1.5 mg


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