Medicare Part D coverage · 250 · RxCUI 245220
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 is covered by 4,291 Medicare Part D plans (84.9% of enrollable products), averaging Tier 2.7, with prior authorization required on 17.1% of covering formularies.
- 84.9%
- Plan coverage
- 4,291
- Plans covering
- T2.7
- Avg tier
- 17.1%
- Prior auth required
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 250) appears on 199 distinct formulary files spanning 4,291 Medicare Part D plan offerings - 84.9% 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
- 84.9%
- 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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
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 (84.9% 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.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- 3 ML insulin aspart, human 100 UNT/ML Cartridge [NovoLog] T2.7
- aliskiren 150 MG Oral Tablet T2.7
- cyclosporine, modified 100 MG Oral Capsule T2.7
- Niacinamide insulin aspart, human 100 UNT/ML Injectable Solution [Fiasp] T2.7
- tazarotene 1 MG/ML Topical Cream T2.7
- tenofovir disoproxil fumarate 300 MG Oral Tablet T2.7
Similar prior-authorization rate
- chlorpromazine hydrochloride 30 MG/ML Oral Solution 17.1% PA
- chlorpromazine hydrochloride 100 MG/ML Oral Solution 17.2% PA
- ibandronic acid 150 MG Oral Tablet 17% PA
- {14 (estrogens, conjugated (USP) 0.625 MG / medroxyprogesterone acetate 5 MG Oral Tablet) / 14 (estrogens, conjugated (USP) 0.625 MG Oral Tablet) } Pack [Premphase 28 Day] 17.3% PA
- morphine sulfate 20 MG/ML Oral Solution 16.9% PA
- tolcapone 100 MG Oral Tablet 17.4% PA