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 Virginia (CMS PDP Region 07).
Not on any stand-alone Part D formulary in Virginia
None of the 9 stand-alone Part D (PDP) plans in CMS PDP Region 07 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.