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 Oklahoma (CMS PDP Region 23).
Not on any stand-alone Part D formulary in Oklahoma
None of the 11 stand-alone Part D (PDP) plans in CMS PDP Region 23 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.