PEG-3350, ELECTROLYTES, AND ASCORBATE Kit
Also known as Polyethylene Glycol 3350, Sodium Sulfate, Sodium Chloride, Potassium Chloride, Sodium Ascorbate, And Ascorbic Acid. Coverage in American Samoa (CMS PDP Region 35).
Not on any stand-alone Part D formulary in American Samoa
None of the 1 stand-alone Part D (PDP) plans in CMS PDP Region 35 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.