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Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl 500 mg/20mL / 26.66 mg/20mL / 400 mg/20mL / 10 mg/20mL Medicare Part D Coverage

Brand name: Tesalon Jarabe Adulto
Dosage form
SYRUP
Route
ORAL
0%
of Medicare Part D plans
cover Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl

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Frequently Asked Questions about Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl

0% of Medicare Part D plans cover Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl. Coverage varies by plan and geographic area.

Costs vary by plan. Enter your ZIP code above to see exact prices for plans in your area.

The tier placement for Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl varies by plan. Compare plans to find the best tier for your medication.

0% of plans require prior authorization for Acetaminophen, Dextromethorphan HBr, Guaifenesin USP, Phenylephrine HCl. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →