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Dextrose and Sodium Chloride Medicare Coverage in Pennsylvania

100%
of plans in Pennsylvania
cover Dextrose and Sodium Chloride
303 of 303 plans
$0.97
Avg 30-day copay in Pennsylvania
30
Plans shown below

Medicare Plans Covering Dextrose and Sodium Chloride 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
Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) Lowest Copay $0.00/mo Tier 1 - Preferred Generic $0.00 N/A None Details →
Complete Blue PPO Signature (PPO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Community Blue Medicare HMO Distinct (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Community Blue Medicare HMO Signature (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Jefferson Health Plans Dual Pearl (HMO D-SNP) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Community Blue Medicare HMO Signature (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Aetna Community HealthChoices (HMO D-SNP) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Erickson Advantage Guardian (HMO-POS I-SNP) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Complete Blue HMO Distinct (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Keystone First VIP Choice (HMO D-SNP) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
HumanaChoice H5525-051 (PPO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
DEVOTED CHOICE GIVEBACK 011 PA (PPO) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
AARP Medicare Advantage Extras from UHC PA-18 (HMO-POS) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
DEVOTED CORE 012 PA (HMO) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Community Blue Medicare HMO Distinct (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Complete Blue PPO Signature (PPO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Community Blue Medicare HMO Signature (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
HumanaChoice SNP-DE H5216-227 (PPO D-SNP) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Jefferson Health Plans Select (HMO D-SNP) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Community Blue Medicare HMO Signature (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Aetna Community HealthChoices (HMO D-SNP) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Geisinger Gold Classic 360 Rx (HMO) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →
Complete Blue HMO Distinct (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
AmeriHealth Caritas VIP Care (HMO D-SNP) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Humana USAA Honor Giveback with Rx (PPO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Humana Gold Plus H6622-035 (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Perennial Advantage Freedom (HMO) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
Humana Gold Plus SNP-DE H5377-003 (HMO D-SNP) $0.00/mo Tier 2 - Generic $0.00 N/A None Details →
DEVOTED GIVEBACK 013 PA (HMO) $0.00/mo Tier 4 - Non-Preferred Drug $0.00 N/A None Details →

Compare All Pennsylvania Plans for Dextrose and Sodium Chloride

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 Dextrose and Sodium Chloride. There are 30 plans available. Coverage and costs vary by specific plan.

The average 30-day copay for Dextrose and Sodium Chloride in Pennsylvania is $0.97 at a preferred pharmacy. Costs vary by plan. Compare plans to find the lowest cost option for you.

Based on current CMS data, Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) offers one of the lowest copays for Dextrose and Sodium Chloride in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.

Dextrose and Sodium Chloride Coverage in Other States

Click any state to see the plans and costs available there.

Coverage data from CMS formulary files for plan year 2026. How we calculate costsNational coverage for Dextrose and Sodium Chloride

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