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 Pennsylvania and West Virginia (CMS PDP Region 06).
Not on any stand-alone Part D formulary in Pennsylvania and West Virginia
None of the 12 stand-alone Part D (PDP) plans in CMS PDP Region 06 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.
5 Medicare Advantage plans in PA, WV 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. PA: 4 plans · WV: 1 plans.