MAGNESIUM SULFATE/ POTASSIUM SULFATE/ SODIUM SULFATE SOLN,ORAL Generic Name MAGNESIUM SULFATE/ POTASSIUM SULFATE/ SODIUM SULFATE SOLN Brand Names SOD SULF-POTASS SULF-MAG SULF, SUPREP Drug Class HYPEROSMOTIC LAXATIVES Formulary Status Prior Auth Required Formulary with prior authorization Copay Tier 2 Last Updated December 1, 2025 Clinical Criteria Summary Inclusion CriteriaFailure unrelated to compliance or other causes, contraindication or intolerance to formulary PEG-3350 bowel prep regimens. Source Documents Download CFU PDF: Magnesium Potassium Sodium Sulfates Oral Solution SUPREP EQV Bowel Prep Criteria Dec 2025