The prescription form of polyethylene glycol is no longer being manufactured, and only the over-the-counter (OTC) versions are available. The Centers for Medicare & Medicaid Services (CMS) excludes OTC medications from the Part D benefit.
With this change, we can no longer cover polyethylene glycol under Part D. Claims for coverage of this drug will be denied based on the CMS decision.
Polyethylene glycol is currently listed as a Tier 1 medication on the 2019 Medicare formulary, and we can’t remove it from the formulary at this point in the year. It will be removed from the 2020 formulary.
Polyethylene glycol is used for constipation and in bowel preparation regimens for colonoscopies. Most medications used for constipation, such as MiraLAX, are available OTC.
There are still several bowel-prep kits on the formulary, including:
- Gavilyte-C, Gavilyte-G and Gavilyte-N covered at Tier 2
- PEG 3350/electrolytes solution covered at Tier 2
If you have any questions, call Broker Support at 1-877-917-8489 or email BrokerServices@healthalliance.org.