{1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]
ascorbic acid
RxCUI: 2045245
What the CMS Formulary Data Shows for {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]
Per the CMS 2026 Part D formulary file, {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] (RxNorm concept RXCUI 2045245, generic name ascorbic acid) appears on 71 distinct formulary files spanning 1,696 Medicare Part D plan offerings - 33.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.5.
Real-world access to {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 56,685 Part D beneficiaries filled {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] in 2023, with total plan-and-beneficiary spending of $8,397,998 and an average per-beneficiary annual cost of $148.15. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] today.
Coverage Details
- Formularies covering
- 71
- Plans covering
- 1,696
- Coverage rate
- 33.5%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 56,685
- Total spending
- $8,397,998
- Avg per beneficiary
- $148.15
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Wellcare Dual Liberty (HMO D-SNP) | WELLCARE OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
| Wellcare Dual Access (HMO-POS D-SNP) | WELLCARE OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $4.80 | FL |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| VIVA Medicare Extra Care (HMO D-SNP) | VIVA HEALTH, INC. | T1 | No | $27.70 | AL |
| Elderplan Advantage For Nursing Home Residents (HMO-POS I-SNP) | ELDERPLAN, INC. | T1 | No | $44.80 | NY |
| MetroPlus Platinum Plan (HMO) | METROPLUS HEALTH PLAN, INC. | T1 | No | $58.80 | NY |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | SUPERIOR HEALTHPLAN, INC. | T3 | No | $0 | TX |
| Wellcare Superior HealthPlan Dual Align (HMO D-SNP) | SUPERIOR HEALTHPLAN, INC. | T3 | No | $0 | TX |
| Wellcare Dual Access Open (PPO D-SNP) | WELLCARE OF MISSISSIPPI, INC. | T3 | No | $0 | MS |
| Wellcare Dual Access Open (PPO D-SNP) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Dual Liberty Sync (HMO D-SNP) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Dual Liberty Sync (HMO D-SNP) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Dual Liberty (HMO-POS D-SNP) | BUCKEYE COMMUNITY HEALTH PLAN, INC. | T3 | No | $0 | OH |
| Wellcare Fidelis Dual Align (HMO D-SNP) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T3 | No | $0 | NJ |
| Wellcare Sunshine Health Dual Align (HMO D-SNP) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Dual Access (HMO-POS D-SNP) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Dual Liberty (HMO-POS D-SNP) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Dual Access (HMO-POS D-SNP) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Dual Liberty Sync (HMO-POS D-SNP) | NEBRASKA TOTAL CARE, INC. | T3 | No | $0 | NE |
| Wellcare Dual Access Sync Open (PPO D-SNP) | NEBRASKA TOTAL CARE, INC. | T3 | No | $0 | NE |
| Wellcare Dual Access (HMO-POS D-SNP) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | MS |
| Wellcare Dual Liberty (HMO-POS D-SNP) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | MS |
| Wellcare Dual Liberty Sync (HMO-POS D-SNP) | WELLCARE OF IOWA, INC. | T3 | No | $0 | IA |
| Wellcare Dual Liberty Open (PPO D-SNP) | WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC. | T3 | No | $0 | NC |
| Wellcare Dual Access Sync Open (PPO D-SNP) | WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC | T3 | No | $0 | KY |
| Wellcare Dual Access (HMO-POS D-SNP) | WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC. | T3 | No | $0 | NC |
| Wellcare Dual Liberty (HMO-POS D-SNP) | WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC. | T3 | No | $0 | NC |
| Wellcare Dual Access Open (PPO D-SNP) | WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC. | T3 | No | $0 | OK |
| Wellcare Delaware First Health Dual Align (HMO-POS D-SNP) | CELTIC INSURANCE COMPANY | T3 | No | $0 | DE |
| Wellcare Dual Access (HMO D-SNP) | NEW YORK QUALITY HEALTHCARE CORPORATION | T3 | No | $0 | NY |
| Wellcare Absolute Total Care Dual Align (HMO D-SNP) | ABSOLUTE TOTAL CARE, INC. | T3 | No | $0 | SC |
| Wellcare Dual Liberty Sync (HMO D-SNP) | SUPERIOR HEALTHPLAN, INC. | T3 | No | $0 | TX |
| Wellcare Fidelis Dual Align (HMO D-SNP) | NEW YORK QUALITY HEALTHCARE CORPORATION | T3 | No | $0 | NY |
| Wellcare Fidelis Dual Liberty Sync (HMO D-SNP) | NEW YORK QUALITY HEALTHCARE CORPORATION | T3 | No | $0 | NY |
Frequently Asked Questions
Is {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] covered by Medicare Part D?
Yes, {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] is covered by 1,696 Medicare Part D plans (33.5% of all Part D formularies).
What tier is {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] on Medicare Part D plans?
{1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] require prior authorization?
0% of Part D formularies require prior authorization for {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu]?
In 2023, total Medicare Part D spending on {1 (ascorbic acid 7540 MG / polyethylene glycol 3350 40000 MG / potassium chloride 1200 MG / sodium ascorbate 48110 MG / sodium chloride 3200 MG Powder for Oral Solution) / 1 (polyethylene glycol 3350 100000 MG / potassium chloride 1000 MG / sodium chloride 2000 MG / sodium sulfate 9000 MG Powder for Oral Solution) } Pack [Plenvu] was $8,397,998, covering 56,685 beneficiaries. The average spend per beneficiary was $148.15.
Read our methodology - how this data is sourced, computed, and verified.