FillMapKP HI Standard Bronze 7500/50 · 60612-60612HI0110020-0About this plan

Does KP HI Standard Bronze 7500/50 cover polidocanol?

1 · Your plan

KP HI Standard Bronze 7500/50

60612-60612HI0110020-0 · ACA · ACA Marketplace

2 · Your medication

polidocanol

polidocanolunder KP HI Standard Bronze 7500/50

Covered — just walk in

Nothing to clear first — take the prescription to an in-network pharmacy.

What you'd pay

$50per 30-day fill

Your plan’s deductible comes first — you pay the full price until it is met.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

Tier: Preferred brand
Approval first: Not needed
Try another first: No
Amount limit: None

Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (2)

2 ML polidocanol 10 MG/ML Injection [Asclera]
2 ML polidocanol 5 MG/ML Injection [Asclera]

← All coverage for polidocanol