PLASMA-LYTE A 526/502/368/37/30 mg/100mL Injection, Solution
Also known as Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride And Magnesium Chloride. Coverage in Puerto Rico (CMS PDP Region 38).
Not on any stand-alone Part D formulary in Puerto Rico
None of the 3 stand-alone Part D (PDP) plans in CMS PDP Region 38 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.
43 Medicare Advantage plans in PR 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. PR: 43 plans.