chlordiazepoxide and amitriptyline hydrochloride Medicare Coverage in Pennsylvania
cover chlordiazepoxide and amitriptyline hydrochloride
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 costs • National coverage for chlordiazepoxide and amitriptyline hydrochloride
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