250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection
glucose
RxCUI: 245220
What the CMS Formulary Data Shows for 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection
Per the CMS 2026 Part D formulary file, 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection (RxNorm concept RXCUI 245220, generic name glucose) appears on 199 distinct formulary files spanning 4,291 Medicare Part D plan offerings - 84.7% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.7.
Real-world access to 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection depends on utilization management as much as tier placement: 17.1% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection today.
Coverage Details
- Formularies covering
- 199
- Plans covering
- 4,291
- Coverage rate
- 84.7%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 17.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| ElderServe MAP (HMO D-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | GROUP HEALTH COOPERATIVE OF EAU CLAIRE | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $0 | NJ |
| 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 |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | No | $0 | GA |
| 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 |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | Yes | $0 | AL |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Humana Dual Integrated (HMO D-SNP) | HUMANA MEDICAL PLAN OF MICHIGAN, INC. | T1 | No | $0 | MI |
| CareOne Plus (HMO-POS) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareOne Plus (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareNeeds Platinum (HMO D-SNP) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareOne Plus (HMO-POS) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareOne Plus (HMO-POS) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareNeeds Plus (HMO D-SNP) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Platinum Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareOne Plus (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Platinum Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareOne Plus (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Platinum Giveback (HMO-POS) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Platinum Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
| CareFree Platinum Giveback (HMO) | CAREPLUS HEALTH PLANS, INC. | T1 | No | $0 | FL |
Frequently Asked Questions
Is 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection covered by Medicare Part D?
Yes, 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection is covered by 4,291 Medicare Part D plans (84.7% of all Part D formularies).
What tier is 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection on Medicare Part D plans?
250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 6.
Does 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection require prior authorization?
17.1% of Part D formularies require prior authorization for 250 ML glucose 100 MG/ML / sodium chloride 2 MG/ML Injection. Step therapy: 0%. Quantity limits: 0%.
Read our methodology - how this data is sourced, computed, and verified.