ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution
ascorbic acid
RxCUI: 800915
What the CMS Formulary Data Shows for ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution
Per the CMS 2026 Part D formulary file, ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution (RxNorm concept RXCUI 800915, generic name ascorbic acid) appears on 68 distinct formulary files spanning 597 Medicare Part D plan offerings - 11.8% 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 2.3.
Real-world access to ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution depends on utilization management as much as tier placement: 0% 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 ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution today.
Coverage Details
- Formularies covering
- 68
- Plans covering
- 597
- Coverage rate
- 11.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| UPMC for Life HMO Premier Rx (HMO) | UPMC HEALTH PLAN, INC. | T1 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T1 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T1 | No | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T1 | No | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T1 | No | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T1 | No | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T1 | No | $0 | PA |
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T1 | No | $0 | CA |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Tufts Health One Care (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | TUFTS HEALTH PUBLIC PLANS, INC. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION | T1 | No | $0 | MA |
| UPMC for Life HMO Rx Choice (HMO) | UPMC HEALTH PLAN, INC. | T1 | No | $3.90 | OH, PA |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE FLORIDA, INC. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | PROCARE ADVANTAGE, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | PROCARE ADVANTAGE, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | AMERICAN HEALTH PLAN OF FL, INC. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | SECUR INC | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | SECUR INC | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE MI, LLC | T1 | No | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | MARQUIS ADVANTAGE, INC. | T1 | No | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | ALIGN SENIOR CARE CALIFORNIA INC. | T1 | No | $12.00 | CA |
| Liberty Medicare Dual Plan (HMO D-SNP) | LIBERTY ADVANTAGE, LLC | T1 | No | $14.70 | NC |
| UPMC for Life HMO Deductible Rx (HMO) | UPMC HEALTH PLAN, INC. | T1 | No | $18.10 | OH, PA |
| KeyCare Advantage (HMO I-SNP) | ISNP VENTURES, LLC | T1 | No | $23.20 | MD |
| American Health Advantage of Mississippi (HMO I-SNP) | AMERICAN HEALTH PLAN OF MS, INC. | T1 | No | $23.80 | MS |
| Senior Care (HMO I-SNP) | LIFEWORKS ADVANTAGE, LLC | T1 | No | $24.60 | VA |
| UPMC for Life PPO Rx Choice (PPO) | UPMC HEALTH NETWORK, INC. | T1 | No | $25.00 | PA |
| PruittHealth Premier (HMO I-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | No | $25.40 | GA |
| Georgia Health Advantage (HMO I-SNP) | GEORGIA ASSURANCE, INC. | T1 | No | $25.40 | GA |
| Georgia Health Advantage Choice (HMO I-SNP) | GEORGIA ASSURANCE, INC. | T1 | No | $25.40 | GA |
| American Health Advantage of Tennessee (HMO I-SNP) | AMERICAN HEALTH PLAN, INC. | T1 | No | $27.70 | TN |
| Simpra Advantage Nursing Home Plan (PPO I-SNP) | SIMPRA ADVANTAGE, INC. | T1 | No | $27.70 | AL |
| American Health Advantage of Oklahoma (HMO I-SNP) | OKLAHOMA SUPERIOR SELECT, INC. | T1 | No | $28.20 | OK |
| NHC Advantage (HMO I-SNP) | NHC ADVANTAGE, LLC | T1 | No | $31.00 | MO, NC, SC, TN |
| Perennial Advantage Strive (HMO I-SNP) | PERENNIAL ADVANTAGE OF OHIO, INC. | T1 | No | $31.40 | OH |
| Perennial Advantage Strive (HMO I-SNP) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | No | $32.70 | PA |
| American Health Advantage of Pennsylvania (HMO I-SNP) | AMERICAN HEALTH PLAN OF PENNSYLVANIA INC | T1 | No | $32.70 | PA |
| Lagniappe Advantage (PPO I-SNP) | LAGNIAPPE ADVANTAGE INSURANCE COMPANY | T1 | No | $32.90 | LA |
| American Health Advantage of Louisiana (HMO I-SNP) | DIGNITY CARE CORPORATION | T1 | No | $32.90 | LA |
| UPMC for Life PPO High Deductible Rx (PPO) | UPMC HEALTH NETWORK, INC. | T1 | No | $33.00 | PA |
| UPMC for Life HMO Rx (HMO) | UPMC HEALTH PLAN, INC. | T1 | No | $33.70 | OH, PA |
Frequently Asked Questions
Is ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution covered by Medicare Part D?
Yes, ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution is covered by 597 Medicare Part D plans (11.8% of all Part D formularies).
What tier is ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution on Medicare Part D plans?
ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution require prior authorization?
0% of Part D formularies require prior authorization for ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution. Step therapy: 0%. Quantity limits: 0%.
Read our methodology - how this data is sourced, computed, and verified.