peg 3350/sod sulf/sod bicarb/sod chloride/potassium chloride

236 gram-22.74 gram-6.74 gram-5.86 gram-2.97 gram, 240 gram-22.72 gram-6.72 gram-5.84 gram-2.98 gram — Solution

LAXATIVES-CATHARTICS-STOOL SOFTENERS

Also known as: GAVILYTE-G GAVILYTE-C PEG-3350 AND ELECTROLYTES

Coverage by Insurer

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
Source: PDF  ·  Formulary date: Jan 1, 2026  ·  Checked: 13 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
Cigna Plus NC 4-Tier Formulary 2026
via Peg-3350 And Electrolytes
Tier 1 - Generic None
Source: Excel (XLSX)  ·  Formulary date: Jan 5, 2026  ·  Checked: 13 minutes ago
Plan Tier Prior Auth Step Therapy Quantity Limit Restrictions
TRICARE Uniform Formulary 2026 Tier 1 - Basic Core Formulary None
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