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chlordiazepoxide and amitriptyline hydrochloride Medicare Coverage in Pennsylvania

100%
of plans in Pennsylvania
cover chlordiazepoxide and amitriptyline hydrochloride
42 of 42 plans
30
Plans shown below

Medicare Plans Covering chlordiazepoxide and amitriptyline hydrochloride in Pennsylvania

Sorted by lowest 30-day copay at a preferred pharmacy. Prices shown are estimates from CMS formulary data.

Plan Name Monthly Premium Tier 30-day Copay Stars Restrictions Action
Security Blue HMO-POS Standard (HMO-POS) Lowest Copay $51.80/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Security Blue HMO-POS Standard (HMO-POS) $51.80/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Security Blue HMO-POS Deluxe (HMO-POS) $95.90/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Security Blue HMO-POS Deluxe (HMO-POS) $95.90/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Freedom Blue PPO Select (PPO) $95.70/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Freedom Blue PPO Standard (PPO) $98.20/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Freedom Blue PPO Select (PPO) $115.70/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Freedom Blue PPO Deluxe (PPO) $122.40/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Freedom Blue PPO Classic (PPO) $140.90/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Freedom Blue PPO Classic (PPO) $145.40/mo Tier 4 - Non-Preferred Drug $95.00 N/A None Details →
Keystone 65 Focus Rx (HMO-POS) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Focus Rx (HMO-POS) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Personal Choice 65 Achieve Rx (PPO) $0.00/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →
Keystone 65 Basic Rx (HMO) $0.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $3.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $3.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $3.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $3.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $10.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $10.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx Choice (HMO) $10.90/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Deductible Rx (HMO) $18.10/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life PPO Rx Choice (PPO) $25.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
UPMC for Life PPO Rx Choice (PPO) $25.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
UPMC for Life PPO Rx Choice (PPO) $30.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
UPMC for Life PPO Rx Choice (PPO) $30.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
Keystone 65 Essential Rx (HMO-POS) $31.00/mo Tier 4 - Non-Preferred Drug 0.3% N/A None Details →
UPMC for Life PPO High Deductible Rx (PPO) $33.00/mo Tier 4 - Non-Preferred Drug 0.4% N/A None Details →
UPMC for Life HMO Rx (HMO) $33.70/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →
UPMC for Life HMO Rx (HMO) $33.70/mo Tier 4 - Non-Preferred Drug 0.5% N/A None Details →

Compare All Pennsylvania Plans for chlordiazepoxide and amitriptyline hydrochloride

Enter your exact ZIP code to see plans available in your specific county, ranked by total annual cost.

Frequently Asked Questions

100% of Medicare Part D plans in Pennsylvania cover chlordiazepoxide and amitriptyline hydrochloride. There are 30 plans available. Coverage and costs vary by specific plan.

Costs vary by plan. Compare plans to find the lowest cost option for you.

Based on current CMS data, Security Blue HMO-POS Standard (HMO-POS) offers one of the lowest copays for chlordiazepoxide and amitriptyline hydrochloride in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.

chlordiazepoxide and amitriptyline hydrochloride Coverage in Other States

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Coverage data from CMS formulary files for plan year 2026. How we calculate costsNational coverage for chlordiazepoxide and amitriptyline hydrochloride

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