ISOLYTE S PH 7.4 .53/.5/.37/.037/.03/.012/.00082 g/100mL Injection, Solution
Also known as Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride, Magnesium Chloride, Sodium Phosphate, Dibasic, And Potassium Phosphate. Coverage in American Samoa (CMS PDP Region 35).
1 of 1 stand-alone Part D plans in American Samoa cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 25% | 25% | $0.0069 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.