ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep]
ascorbic acid
RxCUI: 800918
What the CMS Formulary Data Shows for ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep]
Per the CMS 2026 Part D formulary file, ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] (RxNorm concept RXCUI 800918, generic name ascorbic acid) appears on 1 distinct formulary file spanning 2 Medicare Part D plan offerings - 0% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 1, with a cross-plan average of Tier 1.
Real-world access to ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 517 Part D beneficiaries filled ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] in 2023, with total plan-and-beneficiary spending of $73,171 and an average per-beneficiary annual cost of $141.53. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] today.
Coverage Details
- Formularies covering
- 1
- Plans covering
- 2
- Coverage rate
- 0%
- Tier range
- Tier 1, Preferred Generic
- Average tier
- Tier 1, Preferred Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 517
- Total spending
- $73,171
- Avg per beneficiary
- $141.53
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep]
2 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
Frequently Asked Questions
Is ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] covered by Medicare Part D?
Yes, ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] is covered by 2 Medicare Part D plans (0% of all Part D formularies).
What tier is ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] on Medicare Part D plans?
ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] averages Tier 1 across Part D plans, ranging from Tier 1 to Tier 1.
Does ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] require prior authorization?
0% of Part D formularies require prior authorization for ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep]?
In 2023, total Medicare Part D spending on ascorbic acid 4700 MG / polyethylene glycol 3350 100000 MG / potassium chloride 1015 MG / sodium ascorbate 5900 MG / sodium chloride 2690 MG / sodium sulfate 7500 MG Powder for Oral Solution [MoviPrep] was $73,171, covering 517 beneficiaries. The average spend per beneficiary was $141.53.
Read our methodology - how this data is sourced, computed, and verified.