Replacement Preparations

Showing 1–12 of 64 results

NAME	ALSO KNOW AS	DRUG CATEGORY	FORMULARY CATEGORY	WHAT WE COVER	COST SHARE
Calcium Acetate (Phosphate Binder) Caps 667Mg (Generic)	No Brand Option Available	Replacement Preparations	1	Generic	$14
Calcium Acetate (Phosphate Binder) Tabs 667Mg (Generic)	No Brand Option Available	Replacement Preparations	1	Generic	$14
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 5-0.2 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 10-0.2 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 10-0.45 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 5-0.225 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 5-0.33 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 5-0.45 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 5-0.9 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Dextrose W/ Sodium Chloride Soln (Generic)	Dextrose-Nacl Soln 2.5-0.45 % (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-148 Soln (Generic)	Plasma-Lyte 148 Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-A Soln (Generic)	Plasma-Lyte A Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-M In Dextrose Soln (Generic)	Normosol-M In D5W Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-Mb In Dextrose Soln (Generic)	Ionosol-Mb In D5W Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-P In Dextrose Soln (Generic)	Isolyte-P In D5W Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-R (Ph 7.4) Soln (Generic)	Normosol-R Ph 7.4 Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-R In Dextrose Soln (Generic)	Normosol-R In D5W Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Electrolyte-S Soln (Generic)	Isolyte-S Soln (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
K-Tab Tbcr 10 Meq (Brand)	Potassium Chloride Tbcr 10Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
K-Tab Tbcr 20 Meq (Brand)	Potassium Chloride Tbcr 20Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
K-Tab Tbcr 8 Meq (Brand)	Potassium Chloride Tbcr 8Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con 10 Tbcr 10 Meq (Brand)	Potassium Chloride Tbcr 10Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con M10 Tbcr 10 Meq (Brand)	Potassium Chloride Microencapsulated Crystals Er Tbcr 10Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con M15 Tbcr 15 Meq (Brand)	Potassium Chloride Microencapsulated Crystals Er Tbcr 15Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con M20 Tbcr 20 Meq (Brand)	Potassium Chloride Microencapsulated Crystals Er Tbcr 20Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con Pack 20 Meq (Brand)	Potassium Chloride Pack 20Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con Sprinkle Cpcr 10 Meq (Brand)	Potassium Chloride Cpcr 10Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con Sprinkle Cpcr 8 Meq (Brand)	Potassium Chloride Cpcr 8Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Klor-Con Tbcr 8 Meq (Brand)	Potassium Chloride Tbcr 8Meq (Generic)	Replacement Preparations	3	Non-Formulary Brand	$68
Phoslyra Soln 667 Mg/5Ml (Brand)	Calcium Acetate (Phosphate Binder) Soln 667Mg/5Ml (Generic)	Replacement Preparations	2	Formulary Brand	$38
Potassium Chloride Cpcr 10Meq (Generic)	Klor-Con Sprinkle Cpcr 10 Meq (Brand)	Replacement Preparations	1	Generic	$14
Potassium Chloride Cpcr 8Meq (Generic)	Klor-Con Sprinkle Cpcr 8 Meq (Brand)	Replacement Preparations	1	Generic	$14
Potassium Chloride In D5W Lactated Ringers Soln (Generic)	Kcl-Lactated Ringers-D5W Soln 20 Meq/L (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Potassium Chloride In Dextrose & Sodium Chloride Soln (Generic)	Kcl In Dextrose-Nacl Soln 40-5-0.45 Meq/L-%-% (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A
Potassium Chloride In Dextrose & Sodium Chloride Soln (Generic)	Kcl In Dextrose-Nacl Soln 10-5-0.45 Meq/L-%-% (Brand)	Replacement Preparations	MA	Administered in Medical Office	N/A

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