How much does Plasma-Lyte A cost?

Pricing for Plasma-Lyte A varies by insurance plan, dose, and pharmacy. Our database does not show a fixed cost because prices change faster than we can verify. For current pharmacy prices, check your insurance's formulary tier (in the prior-authorization section), use the GoodRx or Cost Plus Drugs deep links on this page, or ask your pharmacist to run a test claim. If a copay card is listed, it usually drops the out-of-pocket significantly for commercial insurance.

Does Plasma-Lyte A need prior authorization?

Plasma-Lyte A appears on 1 payer formulary in our database. PA requirements vary by payer — see the prior-authorization table on this page for specifics. In general, specialty and brand-name drugs are more likely to require PA than generic equivalents.

Is there a copay card or patient assistance program for Plasma-Lyte A?

We haven't verified an active copay card or PAP for Plasma-Lyte A in our current data. Check NeedyMeds or RxAssist for independent directories, or submit what you find via our "Report a broken link" form.

What is Plasma-Lyte A used to treat?

Plasma-Lyte A (generic: Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride) is indicated for Electrolyte Imbalance. Click any condition name on this page for more detail.

Does Plasma-Lyte A have a generic version?

The generic name for Plasma-Lyte A is Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride. Whether a generic is currently available depends on patent status — check the FDA Orange Book or ask your pharmacist. Generics are often substantially cheaper than brand-name drugs.

Plasma-Lyte A

Generic: Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride

Verified·Apr 23, 2026

Manufacturer: Baxter
NDC: 0338-9591
RxCUI: 801109
Route: INTRAVENOUS
ICD-10 indication: E87.8

Affordability Check

How much will you actually pay for Plasma-Lyte A?

In 30 seconds, see every legitimate way to afford Plasma-Lyte A — Medicare copay, manufacturer copay card, Patient Assistance Program, grants, or cash.

Check my options →

About Plasma-Lyte A

What is this medication?

Plasma-Lyte A is a sterile, nonpyrogenic isotonic solution intended for intravenous administration. It is a specific type of electrolyte replacement fluid that contains a balanced mixture of sodium chloride, potassium chloride, magnesium chloride, sodium acetate, and sodium gluconate. Because its chemical composition and pH level are designed to closely resemble the natural makeup of human blood plasma, it is often referred to as a balanced crystalloid solution.

Medical professionals typically prescribe this medication to restore fluid and electrolyte balance in patients who are dehydrated or undergoing surgery. It is commonly used as a source of water and electrolytes or as an alkalinizing agent to treat conditions like metabolic acidosis. By providing necessary minerals and helping to stabilize the body's acid-base balance, it supports vital physiological functions during periods of physical stress or illness.

Copay & patient assistance

Detailed copay and financial assistance information is not publicly available for this medication at this time. Please consult your pharmacist or the manufacturer's official patient support program for more details.

External links go directly to the manufacturer's portal. RxCopays does not receive compensation for referrals.

Compare pricing elsewhere

RxCopays doesn't sell drugs or take referral fees. Here are the transparent-pricing directories we recommend checking alongside your insurance formulary.

Cost Plus Drug Company

Mark Cuban's transparent-pricing pharmacy — manufacturer cost + 15% markup + $5 dispensing fee. No insurance needed. Search alphabetically for Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride.

Browse Cost Plus medications →

GoodRx

Compare local pharmacy prices with GoodRx coupons. Use the price with your insurance or without — whichever is cheaper.

Lookup Plasma-Lyte A →

NeedyMeds

Independent nonprofit directory of patient assistance programs, copay cards, and charity co-pay foundations.

Search for Sodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride and Magnesium Chloride →

RxAssist

PAP directory maintained by Volunteers in Health Care at Brown University. Free, no ads.

Search PAPs →

We deep-link because transparency helps patients. None of these partners pay RxCopays.

Prescribing information

From the FDA-approved label for Plasma-Lyte A. Official source: DailyMed (NLM) · Label effective Sep 26, 2023

Indications and usage

INDICATIONS AND USAGE Physiolyte™ (A Physiological Irrigating Solution) is indicated for all general irrigation, washing, and rinsing purposes which permit use of a sterile, nonpyrogenic electrolyte solution.

Dosage and administration

DOSAGE AND ADMINISTRATION As required for irrigation. The dose is dependent upon the capacity or surface area of the structure to be irrigated and the nature of the procedure. When used as a vehicle for other drugs, the directions of the additive's manufacturer should be followed. Some additives may be incompatible. Consult with pharmacist. When introducing additives, use aseptic techniques. Mix thoroughly. Do not store. Solutions should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permits.

Contraindications

CONTRAINDICATIONS Physiolyte is not for injection by usual parenteral routes. An electrolyte solution should not be used for irrigation during electrosurgical procedures.

Warnings

WARNINGS FOR IRRIGATION ONLY. NOT FOR INJECTION. Irrigating fluids have been demonstrated to enter the systemic circulation in relatively large volumes; thus, irrigation solutions must be regarded as systemic drugs. Absorption of large amounts can cause fluid and/or solute overload resulting in dilution of serum electrolyte concentrations, overhydration, congested states or pulmonary edema. The risk of dilutional states is inversely proportional to the electrolyte concentrations of the administered parenteral solutions. The risk of solute overload causing congested states with peripheral and pulmonary edema is directly proportional to the electrolyte concentrations. Do not warm above 150°F (66°C). After opening container, it's contents should be used promptly to minimize the possibility of bacterial growth or pyrogen formation. Discard unused portion of irrigating solution since it contains no preservatives.

Adverse reactions

ADVERSE REACTIONS Possible adverse effects arising from the irrigation of body cavities, tissues, or indwelling catheters and tubes can be minimized when proper procedures are followed. Displaced catheters or drainage tubes can lead to irrigation or infiltration of unintended structures or cavities. Excessive volume or pressure during irrigation of closed cavities may cause undue distension or disruption of tissues. Accidental contamination from careless technique may transmit infection. If an adverse reaction does occur, discontinue administration of the irrigant, evaluate the patient, institute appropriate therapeutic countermeasures, and save the remainder of the fluid for examination if deemed necessary.

Use in pregnancy

Pregnancy Teratogenic Effects Animal reproduction studies have not been conducted with Physiolyte (A Physiological Irrigating Solution). It is also not known whether Physiolyte (A Physiological Irrigating Solution) can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Physiolyte (A Physiological Irrigating Solution) should be given to a pregnant woman only if clearly needed.

Label text is reproduced as-is from the FDA-approved label. We do not paraphrase, summarize, or omit. Content above is for informational purposes only and is not medical advice. Always consult your prescribing clinician or pharmacist before making decisions about your medication.

Conditions we've indexed resources for

Click a condition to see copay cards, grants, and PA rules specific to it. For the full list of FDA-approved indications, see Prescribing information above.

Electrolyte Imbalance

Medicare Part D coverage

How Plasma-Lyte A appears across Medicare Part D plan formularies nationally. Source: CMS monthly Prescription Drug Plan file (2026-04-30).

Covered by plans

21%

1,161 of 5,509 plans

Most common tier

Tier 4

On 46% of covering formularies

Prior authorization required

of covering formularies

Tier	Formularies on this tier	Share
Tier 1 (preferred generic)	3	9%
Tier 2 (generic)	5	14%
Tier 3 (preferred brand)	11	31%
Tier 4 (non-preferred brand)	16	46%

Step therapy: 0% of formularies

Quantity limits: 0% of formularies

Coverage breadth: 35 of 65 formularies

How to read this:plans on the same formulary share tier + PA rules. Your specific plan's copay depends on (a) the tier above, (b) your plan's cost-share for that tier, (c) whether you're in the initial coverage phase or past the 2026 $2,000 out-of-pocket cap. For your exact plan, check its Summary of Benefits or log in to your Medicare.gov account. Copay cards don't apply to Medicare (federal law).

Prior authorization & coverage

Payer	PA	Step therapy	Copay tier
— Medicare Part D	—	—	—

Payer

Step therapy

Copay tier

—

Medicare Part D

—

Related drugs

How this page is sourced

Drug identity verified against openFDA NDC Directory.
Label text (when shown) originates from NLM DailyMed.
Copay and assistance URLs verified periodically; if you hit a broken link, tell us.