GOLYTELY 236/22.74/6.74/5.86/2.97 g/4L Powder, For Solution
Also known as Polyethylene Glycol 3350, Sodium Sulfate Anhydrous, Sodium Bicarbonate, Sodium Chloride, Potassium Chloride. Coverage in California (CMS PDP Region 32).
Not on any stand-alone Part D formulary in California
None of the 12 stand-alone Part D (PDP) plans in CMS PDP Region 32 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.
2 Medicare Advantage plans in CA do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. CA: 2 plans.