Dextran, Polyethylene glycol 400, Povidone, Tetrahydrozoline .1 g/100mL / 1 g/100mL / 1 g/100mL / .05 g/100mL Medicare Part D Coverage
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Frequently Asked Questions about Dextran, Polyethylene glycol 400, Povidone, Tetrahydrozoline
0% of Medicare Part D plans cover Dextran, Polyethylene glycol 400, Povidone, Tetrahydrozoline. 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 Dextran, Polyethylene glycol 400, Povidone, Tetrahydrozoline varies by plan. Compare plans to find the best tier for your medication.
0% of plans require prior authorization for Dextran, Polyethylene glycol 400, Povidone, Tetrahydrozoline. 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 →