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Verified against CMS.gov · on Apr 1, 2026 Plan ID: H3924-065 Cross-check on Medicare.gov →

Geisinger Gold Preferred Complete Rx (PPO)

Plan Year 2026
$0.00 /month
Monthly Premium
Among the lowest-premium plans in 2026
$0.00 Annual Deductible
1,027 Drugs Covered
1 States Served

Top Covered Drugs

Most popular medications covered by this plan, ordered by national search frequency. Click any drug to see exact copay, restrictions, and alternatives.

# Drug Name Type Tier 30-Day Copay
1 Clozapine Brand Tier 4 $0.00 Details
2 ISENTRESS RALTEGRAVIR Brand Tier 3 $0.00 Details
3 Lorbrena lorlatinib Brand Tier 5 $0.00 Details
4 Daurismo glasdegib Brand Tier 5 $0.00 Details
5 Fetzima LEVOMILNACIPRAN HYDROCHLORIDE Brand Tier 4 $0.00 Details
6 M-M-R II measles, mumps, and rubella virus vaccine live Brand Tier 6 $0.00 Details
7 RETEVMO selpercatinib Brand Tier 5 $0.00 Details
8 Kaletra Lopinavir and Ritonavir Brand Tier 4 $0.00 Details
9 HYDROCODONE BITARTRATE AND ACETAMINOPHEN Brand Tier 2 $0.00 Details
10 Buspirone Hydrochloride Brand Tier 2 $0.00 Details
11 ENTRESTO Sacubitril and Valsartan Brand Tier 3 $0.00 Details
12 bexarotene Brand Tier 3 $0.00 Details
13 VARIVAX Varicella Virus Vaccine Live Brand Tier 6 $0.00 Details
14 Gentamicin Sulfate Brand Tier 2 $0.00 Details
15 Fluphenazine Hydrochloride Brand Tier 4 $0.00 Details
16 Trifluoperazine Hydrochloride trifluoperazine hydrochloride Brand Tier 3 $0.00 Details
17 Paxlovid nirmatrelvir and ritonavir Brand Tier 3 $0.00 Details
18 Thioridazine Hydrochloride thioridazine hydrochloride Brand Tier 3 $0.00 Details
19 Lorbrena lorlatinib Brand Tier 5 $0.00 Details
20 DELSTRIGO doravirine, lamivudine, and tenofovir disoproxil fumarate Brand Tier 5 $0.00 Details

Showing 20 of 1,027 covered drugs.

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States Served (1)

This plan is available to Medicare beneficiaries in the following states.

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