Diphenoxylate Hydrochloride and Atropine Sulfate Medicare Coverage in Pennsylvania
cover Diphenoxylate Hydrochloride and Atropine Sulfate
Medicare Plans Covering Diphenoxylate Hydrochloride and Atropine Sulfate 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 |
|---|---|---|---|---|---|---|
| AmeriHealth Caritas VIP Care (HMO D-SNP) Lowest Copay | $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 → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Medicare Advantra Dual Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| Aetna Medicare Advantra Dual (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $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 → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | $28.80/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | $29.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | $32.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Aetna Medicare Longevity (HMO I-SNP) | $32.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Standard (HMO-POS) | $51.80/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Standard (HMO-POS) | $51.80/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Deluxe (HMO-POS) | $95.90/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Security Blue HMO-POS Deluxe (HMO-POS) | $95.90/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Freedom Blue PPO Select (PPO) | $95.70/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Freedom Blue PPO Standard (PPO) | $98.20/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Freedom Blue PPO Select (PPO) | $115.70/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Freedom Blue PPO Deluxe (PPO) | $122.40/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Freedom Blue PPO Classic (PPO) | $140.90/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Freedom Blue PPO Classic (PPO) | $145.40/mo | Tier 3 - Preferred Brand | $45.00 | N/A | None | Details → |
| Wellcare Assist (HMO-POS) | $32.70/mo | Tier 4 - Non-Preferred Drug | $100.00 | N/A | None | Details → |
| Wellcare Dual Select (HMO-POS D-SNP) | $32.70/mo | Tier 4 - Non-Preferred Drug | $100.00 | N/A | None | Details → |
| HealthSpring Achieve (HMO C-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | 0.5% | N/A | None | Details → |
| Community Blue Medicare HMO Distinct (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | 0.3% | N/A | None | Details → |
Compare All Pennsylvania Plans for Diphenoxylate Hydrochloride and Atropine Sulfate
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Frequently Asked Questions
100% of Medicare Part D plans in Pennsylvania cover Diphenoxylate Hydrochloride and Atropine Sulfate. 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, AmeriHealth Caritas VIP Care (HMO D-SNP) offers one of the lowest copays for Diphenoxylate Hydrochloride and Atropine Sulfate in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Diphenoxylate Hydrochloride and Atropine Sulfate 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 Diphenoxylate Hydrochloride and Atropine Sulfate
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