MOVIPREP Kit
Also known as Polyethylene Glycol 3350, Sodium Sulfate, Sodium Chloride, Potassium Chloride, Ascorbic Acid, Sodium Ascorbate. 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.