ISOLYTE P IN DEXTROSE 5/.32/.13/.031/.026 g/100mL Injection, Solution
Also known as Dextrose, Sodium Acetate, Potassium Chloride, Magnesium Chloride, And Potassium Phosphate, Dibasic. Coverage in Oregon and Washington (CMS PDP Region 30).
3 of 10 stand-alone Part D plans in Oregon and Washington cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
110 Medicare Advantage plans in OR, WA do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. OR: 41 plans · WA: 69 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Saver from UHC (PDP)$38.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 36% | — | $0.0110 | — | None |
| SilverScript Choice (PDP)$85.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $0.0109 | — | None |
| AARP Medicare Rx Preferred from UHC (PDP)$110.00/mo premium · $130.00 deductible | 4Non-Preferred Drug | 37% | — | $0.0110 | — | 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.