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Polyethylene glycol 3350 3350 17 g/17g Powder, For Solution — NDC 00904-6931-81 package photo

Polyethylene glycol 3350 3350 17 g/17g Powder, For Solution

by Major Pharmaceuticals · 100 PACKET in 1 CARTON (0904-6931-81) / 17 g in 1 PACKET
NDC 00904-6931-81
🏷️ FDA NDC (as labeled) 0904-6931-81 billing pads the labeler segment with a zero
This package
Contains17 g in 1 packet Cost per ea$1.15 NADAC Per package$115.47 / 100 packets Pack sizes4 compare ↓
Also priced by: Medicaid pays $0.1554/unit — full pricing hub ↓
Also comes in: 14 packets 00904-6931-26 17 g 00904-6931-86 30 packets 00904-6931-76
OTC Generic On market Non-controlled
🗂️ Data synced Jul 24, 2026 · sources: openFDA · FDA label (DailyMed) · FDA Orange & Purple Book · First Databank · CMS NADAC, ASP, Medicare & Medicaid · RxNorm
📋 All sources & update times →

This page is curated, coded, and maintained by

Compiled from public FDA, CMS, DailyMed, NADAC, and related drug data sources. Editorial policy

🆔 Identity & classification

FDA NDC (as labeled) 0904-6931-81
Product NDC 0904-6931
11-digit billing NDC 00904693181
NCPDP billing unit EA — each (per item)
RxCUI 876193
UNII G2M7P15E5P
UPC 0309046931263
Application # ANDA203928
SPL Set ID ddc9d2b1-87d8-44fa-bac6-0a7261f33564
Established class (EPC) Osmotic Laxative
Mechanism of action Osmotic Activity
Physiologic effect Stimulation Large Intestine Fluid/Electrolyte Secretion
DEA schedule Non-controlled
Marketing category ANDA
Marketing status On market
FDA listing status Listed (active directory)
Marketing start 2019-06-30
Route ORAL
Dosage form POWDER, FOR SOLUTION
Substance POLYETHYLENE GLYCOL 3350
GPI-14 46600033003020
GPI class PEG 3350
GCN Seq No 034313
GCN 86211
HICL code 022819
Ingredient (HICL) Polyethylene Glycol 3350
HIC1 code D
Therapeutic class — broad (HIC1) Biliary System/Gastro-Intestinal System
HIC2 code D6
Therapeutic class — intermediate (HIC2) Drugs Acting Principally On The Colon
HIC3 code D6S
Therapeutic class — specific (HIC3) Laxatives And Cathartics
AHFS code 56:12.00.00
AHFS class Cathartics And Laxatives
FDB label name POLYETHYLENE GLYCOL 3350 POWD
FDB brand name Polyethylene Glycol 3350
Legend status O — Over-the-counter (OTC) drug or device
Why two NDCs? The FDA registers this code as 0904-6931-81 — a 4-4-2 layout, and that's what's printed on the package and shown on DailyMed. For insurance claims, every NDC is standardized to a uniform 11-digit 5-4-2 format by adding a zero to the labeler segment → 00904-6931-81. Same drug, same package — only the format differs.
Where does this data come from?
Identifiers from the FDA openFDA NDC Directory and Structured Product Labeling; RxCUI from RxNorm (NLM); GPI from Medi-Span; GCN / HIC / AHFS / legend from First Databank.

🏷️ RxNorm drug class

This medicine belongs to the Osmotic Laxative class.

Pharmacologic class Osmotic Laxative
How it works Osmotic Activity
Where does this data come from?
Therapeutic classes from RxNorm RxClass (U.S. National Library of Medicine) — Established Pharmacologic Class (FDA), ATC drug family (WHO) and mechanism of action, matched by this product’s RxCUI.

🏭 Manufacturer & labeler

LabelerMajor Pharmaceuticals
Application holderSTRIDES PHARMA GLOBAL PTE LTD
FDA applicationANDA203928 (ANDA)
Labeler code00904
First marketedJun 2019
Product typeHuman Otc Drug
Portfolio629 products on file
The labeler markets the product; the application holder owns the FDA approval. They’re often the same company but can differ (e.g. a repackager or an authorized generic). A mailing address / phone appears here when the manufacturer includes it in the product’s FDA label (not all do).
Where does this data come from?
Labeler, application holder and registered establishment from the FDA openFDA NDC Directory and Drugs@FDA; address/contact from the product’s FDA label.

🩺 Clinical

Label name POLYETHYLENE GLYCOL 3350 POWD Ingredient Polyethylene Glycol 3350
📖 What it is MedlinePlus · NLM

Polyethylene glycol 3350 is used to treat occasional constipation. Polyethylene glycol 3350 is in a class of medications called osmotic laxatives. It works by causing water to be retained with the stool. This increases the number of bowel movements and softens the stool so it is easier to pass.

Read the full MedlinePlus article ↗
📗 Our plain-language guide HelloPharmacist
  • You can generally expect a bowel movement within 1 to 3 days after taking it. It's not meant to work in an hour like some other laxatives — it works gradually. If you haven't gone...
  • How long does it take for Polyethylene Glycol 3350 to work?
  • You can stir it into any 4 to 8 ounces of beverage — water, juice, coffee, tea, whatever you like, cold or hot. The key is to stir it well until it's completely dissolved. Don't dr...
  • Can I mix it into any drink, or does it have to be water?
📖 Read our full Polyethylene Glycol 3350 guide →
Where does this data come from?
Plain-language summary from MedlinePlus (U.S. National Library of Medicine); supplement & herbal interactions and nutrient depletion data from the Natural Medicines database; our full guide is HelloPharmacist editorial content.

💊 What it looks like

Color white
One label can cover several strengths, so colors may be combined — always confirm a loose pill against the dispensed prescription label or a pharmacist.
Where does this data come from?
Physical description (imprint, shape, color, scoring, coating) from this product’s FDA Structured Product Labeling (SPL), mirrored from DailyMed / openFDA.

🧪 Inactive Ingredients / Excipients

Inactive ingredients, also called excipients, are components of the drug product other than the active ingredient. They may include fillers, dyes, coatings, preservatives, flavors, or other formulation ingredients.

From the label’s inactive-ingredient sectionnone

This is label-wide narrative text, not a normalized exact-product ingredient list. A label can cover multiple strengths or packages.

Where does this data come from?
Source: official FDA Structured Product Labeling (SPL) via DailyMed and the openFDA label index. Structured IACT rows and label-wide narrative are kept separate; availability and product-level specificity depend on the submitted label.

Inactive ingredient FAQ

Are inactive ingredients the same for every manufacturer?
No. Inactive ingredients can differ by manufacturer, dosage form, strength, and package / product version.
Why might an inactive ingredient be missing?
Some SPLs do not provide a complete structured inactive-ingredient list, and older or unusual labels may only include the information in narrative text.
Can inactive ingredients matter?
Yes. They can matter for allergies, intolerances, dyes, gluten / lactose concerns, preservatives, and formulation differences — but confirm with a pharmacist or the manufacturer when it’s clinically important.

💲 Pricing

A drug doesn't have one price. Each row is a different public payment system, and none is what you'd pay at the counter — that depends on your insurance. The ⓘ on each row explains what it measures.

Price systemPer eaPer package
Retail pharmacies payNADAC · weekly $1.155 $115.47 / 100 packets
Medicaid paysCMS SDUD · 12 mo $0.1554 $15.54 / 100 packets
Medicare drug plans payPart D · quarterly No Part D plan price is available for this NDC in our data.
NADAC price history (per ea) — tap or hover for the price & month
Dec 2021 Jul 2022 Dec 2025 Aug 2026 $1.512 $1.068
▼ Down 14% over the last 23 months.
Where does this data come from?
NADAC (National Average Drug Acquisition Cost) is the CMS weekly pharmacy-acquisition-cost survey — what pharmacies pay. ASP (Average Sales Price) is the CMS Medicare Part B drug-payment file, published quarterly. Medicaid pays is computed by us from CMS State Drug Utilization Data (total reimbursed ÷ units, trailing 12 months) — gross of rebates and inclusive of dispensing fees, so it reflects what Medicaid paid, not an acquisition cost. Medicare drug plans pay is the median negotiated point-of-sale unit cost across plans listing this NDC in the CMS quarterly Prescription Drug Plan pricing files, before rebates. The VA pays is the federal contract price (FSS, and the statutory Big 4 ceiling where listed) from the VA National Acquisition Center pharmaceutical price file. All are free public government data; each measures a different payer, so the figures are not directly comparable.

🔁 Therapeutic equivalents

ProductLabelerPackNADAC/unitTEStatusPrice vs. this
Polyethylene Glycol 3350 3350 17 g/17g 51672-2104-03 Sun 765 g $0.016 — Availability likely save 99%
rugby PEG 3350 3350 17 g/17g 00536-1052-24 Rugby 238 g $0.024 — Availability likely save 98%
good neighbor pharmacy clearlax 3350 17 g/17g 46122-0805-29 Amerisource 238 g $0.024 — Availability likely save 98%
Polyethylene Glycol 3350 17 g/17g 68001-0505-55 BluePoint 238 g $0.024 — Availability likely save 98%
Polyethylene Glycol 3350 3350 17 g/17g 68001-0607-55 BluePoint 238 g $0.024 — Availability likely save 98%
Leader ClearLax 3350 17 g/17g 70000-0704-01 Cardinal 238 g $0.024 — Availability likely save 98%
Polyethylene Glycol 3350 3350 17 g/17g 83324-0002-08 CHAIN 238 g $0.024 — Availability likely save 98%
Polyethylene Glycol 3350, NF Powder for Solution, Laxative 3350 17 g/d 45861-0083-05 Pharmaceutica 238 ds $0.024 — Availability likely save 98%
Clearlax 3350 17 g/17g 70677-1068-01 STRATEGIC 238 g $0.024 — Availability likely save 98%
Good Sense Clear Lax 3350 17 g/17g 00113-0306-01 L. 119 g $0.029 — Availability likely save 98%
Polyethylene Glycol 3350 3350 17 g/17g 45802-0868-01 Padagis 119 g $0.029 — Availability likely save 98%
Good Neighbor Pharmacy ClearLax 3350 17 g/17g 46122-0014-31 Amerisource 119 g $0.029 — Availability likely save 98%
leader clearlax 3350 17 g/17g 70000-0415-01 Cardinal 119 g $0.029 — Availability likely save 98%
foster and thrive clearlax 3350 17 g/17g 70677-1109-01 Strategic 119 g $0.029 — Availability likely save 98%
Polyethylene Glycol 3350 3350 17 g/17g 63739-0760-02 SKY 14 packets $1.127 — Discontinued save 2%
Polyethylene glycol 3350 3350 17 g/17gthis 00904-6931-81 Major 100 packets $1.155 — Availability likely —
Polyethylene Glycol (3350) 3500 17 g/17g 51079-0306-30 Mylan 30 pouches $1.155 — Availability likely —
Polyethylene Glycol 3350 3350 17 g/17g 62559-0157-10 ANI 100 packets $1.155 — Availability likely —
Polyethylene Glycol 3350 3350 17 g/17g 72603-0302-02 NorthStar 14 packets $1.155 — Availability likely —
Polyethylene Glycol 3350 3350 17 g/17g 81033-0762-01 Kesin 100 packets $1.155 — Availability likely —
Polyethylene Glycol 3350 3350 17 g/17g 60687-0431-92 American 100 pouches $1.155 — Availability likely —
good sense clearlax 3350 17 g/17g 00113-1023-03 L. 510 g — — FDA listed —
injoy constipation relief 3350 17 g/17g 00113-6900-02 L. 1 bottle — — FDA listed —
smooth lax 3350 17 g/17g 00363-0306-00 Walgreen 17 g — — FDA listed —
smoothlax 3350 17 g/17g 00363-1323-03 Walgreen 510 g — — FDA listed —
Walgreens 3350 17 g/17g 00363-5260-07 WALGREEN 119 g — — FDA listed —
MiraLAX Orange Flavor 3350 17 g/17g 11523-0122-01 Bayer 238 g — — FDA listed —
MiraLAX 3350 17 g/17g 11523-4357-02 Bayer 20 packets — — FDA listed —
MiraLAX 3350 17 g/17g 11523-7234-01 Bayer 17 g — — Discontinued —
MiraLAX 3350 17 g/17g 11523-7268-03 Bayer 10 packets — — FDA listed —
MiraLAX 3350 17 g/17g 11523-7341-01 Bayer 612 g — — Discontinued —
Polyethylene Glycol 3350 Nf 3350 17 g/17g 11534-0180-19 SUNRISE 119 g — — FDA listed —
up and up powderlax 3350 17 g/17g 11673-0306-01 Target 119 g — — FDA listed —
Laxative 3350 17 g/17g 11822-0306-03 Rite 119 g — — FDA listed —
laxative 3350 17 g/17g 11822-1199-00 Rite 238 g — — FDA listed —
Gavilax 3350 17 g/17g 17856-0310-01 Atlantic 50 cups — — FDA listed —
Gavilax 3350 17 g/17g 17856-0312-01 ATLANTIC 17 g — — FDA listed —
Clearlax 3350 17 g/17g 21130-0637-02 Safeway 238 g — — FDA listed —
signature care clearlax 3350 17 g/17g 21130-0847-01 Safeway 119 g — — FDA listed —
gentle lax 3350 17 g/17g 30142-0306-01 Kroger 119 g — — FDA listed —
Gentlelax 3350 17 g/17g 30142-0504-02 Kroger 238 g — — FDA listed —
Kroger 3350 17 g/17g 30142-0526-07 KROGER 119 g — — FDA listed —
Topcare ClearLax 3350 17 g/17g 36800-0306-01 Topco 119 g — — FDA listed —
clear lax 3350 17 g/17g 37808-0306-01 H 119 g — — FDA listed —
equaline clearlax 3350 17 g/17g 41163-0306-01 United 119 g — — FDA listed —
Dulcolax 3350 17 g/17g 41167-0223-00 Chattem, 765 g — — FDA listed —
clear lax 3350 17 g/17g 41250-0306-01 Meijer 119 g — — FDA listed —
care one clearlax 3350 17 g/17g 41520-0306-01 American 119 g — — FDA listed —
clear lax 3350 17 g/17g 42507-0306-01 HyVee 119 g — — FDA listed —
365 WHOLE FOODS MARKET Polyethylene Glycol 3350 3350 17 g/17g 42681-0059-01 Whole 119 g — — FDA listed —
Gavilax 3350 17 g/17g 43386-0312-07 Lupin 119 g — — FDA listed —
equate clear lax 3350 17 g/17g 49035-0306-01 Wal-Mart 119 g — — FDA listed —
Mix-In Laxative Packets 3350 17 g/17g 49035-0906-03 Wal-Mart 10 packets — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 50090-2430-00 A-S 238 g — — FDA listed —
Gavilax 3350 17 g/17g 50090-5310-00 A-S 238 g — — FDA listed —
Discount Drug Mart 3350 17 g/17g 53943-0652-14 DISCOUNT 238 g — — FDA listed —
Polyethylene glycol 3350 3350 17 g/17g 55154-2328-05 Cardinal 7 packets — — FDA listed —
MiraLAX 3350 17 g/17g 55154-5035-06 Cardinal 6 packets — — FDA listed —
Polyethylene glycol 3350 3350 17 g/17g 55154-8090-05 Cardinal 5 pouches — — FDA listed —
Polyethylene glycol 3350 3350 17 g/17g 55154-8091-05 Cardinal 5 pouches — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 55154-8184-05 Cardinal 7 pouches — — FDA listed —
Exchange Select ClearLax 3350 17 g/17g 55301-0306-03 Army 510 g — — FDA listed —
Comfortlax 3350 17 g/17g 55319-0056-24 Family 119 g — — FDA listed —
dg health clearlax 3350 17 g/17g 55910-0306-01 Dolgencorp, 119 g — — FDA listed —
dg health clearlax 3350 17 g/17g 55910-0846-02 Dolgencorp 238 g — — FDA listed —
clearlax 3350 17 g/17g 56062-0306-02 Publix 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 57896-0489-14 Geri-Care 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 57896-0490-03 Gericare 30 packets — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 58602-0805-01 Aurohealth 119 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 59556-0762-01 Strides 10 packets — — Discontinued —
clearlax 3350 17 g/17g 59640-0797-02 H 238 g — — FDA listed —
purelax 3350 17 g/17g 59779-0306-01 CVS 119 g — — FDA listed —
Gavilax 3350 17 g/17g 63187-0368-23 Proficient 238 g — — FDA listed —
EasyLAX 3350 17 g/17g 63941-0489-14 VALU 238 g — — FDA listed —
kirkland signature laxaclear original prescription strength 3350 17 g/17g 63981-0306-04 Costco 850 g — — FDA listed —
Welby ClearLax 3350 17 g/17g 64024-0306-02 Aldi, 238 g — — FDA listed —
Winco 3350 17 g/17g 67091-0447-08 WINCO 238 g — — FDA listed —
Members Mark clearlax 3350 17 g/17g 68196-0306-07 Sam's 3 bottles — — FDA listed —
berkley and jensen clearlax 3350 17 g/17g 68391-0306-02 BJWC 765 g — — FDA listed —
Gavilax 3350 17 g/17g 68788-7508-02 Preferred 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 68788-8601-02 Preferred 238 g — — FDA listed —
Good Sense Clear Lax 3350 17 g/17g 68788-8795-02 Preferred 238 g — — FDA listed —
Polyethylene Gycol 3350 3350 17 g/g 69168-0473-55 Allegiant 510 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 69230-0324-32 Camber 7 packets — — FDA listed —
purelax 3350 17 g/17g 69842-0458-01 CVS 119 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 70000-0699-02 CARDINAL 10 packets — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 72090-0036-01 PIONEER 30 packets — — FDA listed —
rugby PEG 3350 3350 17 g/17g 72162-2155-02 Bryant 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 72162-2172-02 Bryant 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 72162-2180-02 Bryant 238 g — — FDA listed —
basic care clearlax 3350 17 g/17g 72288-0020-02 Amazon.com 238 g — — FDA listed —
basic care clearlax 3350 17 g/17g 72288-0499-02 Amazon.com 238 g — — FDA listed —
careone clearlax 3350 17 g/17g 72476-0723-03 Retail 510 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 72657-0196-16 GLENMARK 765 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g 73581-0913-40 YYBA 40 packets — — FDA listed —
Topcare ClearLax 3350 17 g/17g 76162-0119-02 Topco 238 g — — FDA listed —
MiraLAX 3350 17 g/17g 76420-0489-10 ASCLEMED 10 packets — — FDA listed —
ez2go Polyethylene Glycol 3350 3350 17 g/17g 76470-0050-50 Valley 119 g — — FDA listed —
Polyethylene Glycol 3350 Powder for Solution 3350 17 g/17g 76470-0069-69 VALLEY 238 g — — FDA listed —
clearlax 3350 17 g/17g 79481-0090-03 Meijer, 510 g — — FDA listed —
Polyethylene Glycol 3350, NF Powder for Solution, Laxative 3350 17 g/d 79739-7116-01 LGM 7 ds — — FDA listed —
Equate ClearLAX 3350 17 g/17g 79903-0114-14 WALMART 238 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 84386-0125-08 Aurobindo 119 g — — FDA listed —
Good Sense Clear Lax 3350 17 g/17g 71205-0447-38 Proficient 238 g — — FDA listed —
Clearlax 3350 17 g/17g 72288-0033-03 Amazon.com 510 g — — FDA listed —
Polyethylene Glycol 3350 3350 17 g/17g 87362-0119-01 The 119 g — — FDA listed —
Peg3350 3350 17 g/17g 00904-7534-26 Major 15 packets — — FDA listed —
Clearlax 3350 17 g/17g 72288-0471-09 Amazon.com 765 g — — FDA listed —
About this product: this is a generic version of the medicine. FDA equivalence ratings are shown when available, and other versions are listed above, least expensive first.
Where does this data come from?
Equivalents are other NDCs of the same ingredient, form and route from the openFDA NDC Directory, ranked least-expensive-first by NADAC. Therapeutic-equivalence (AB) ratings come from the FDA Orange Book; biologics use the FDA Purple Book for biosimilar & interchangeable status.

⏳ Availability & generic status

🏛️
2019
On the market since
Jun 2019
📍
2026
Currently FDA-listed
7 years listed
🔓
·
Generic on the market
this product is a generic
✅This is a generic drug

This product is an FDA-approved generic. Other versions of the same drug are listed under Therapeutic equivalents, least expensive first.

Where does this data come from?
Patents and exclusivity from the FDA Orange Book (small-molecule drugs), refreshed from public FDA data. Generic launch timing is an estimate, not a guarantee.

🗺️ Medicaid utilization & spend

📍 This exact package only: Medicaid data is reported per full 11-digit NDC — labeler, product and pack size — so every number here is for 00904-6931-81, not the drug overall. Other pack sizes report separately.
💊 Pharmacy benefit only: These are Medicaid outpatient pharmacy claims, billed by NDC. They exclude the medical benefit — clinic- or hospital-administered drugs billed under HCPCS J-codes — so drugs used mostly that way (e.g. Avastin, Lucentis, Keytruda) can look low or missing here. That’s expected, not an error.
📅 Q1 2025 – Q4 2025 · 4 quarters of data
ⓘ The newest quarter is usually incomplete when first published; states restate recent quarters in later CMS releases, so the latest figures typically revise upward. State coverage-policy changes can also shift quarter-to-quarter totals.
Prescriptions last 4 qtrs
31.6K
Units reimbursed last 4 qtrs
7.4M
Gross reimbursed last 4 qtrs
$1.14M
Avg / prescription
$36.18
Avg / unit
$0.1554
Latest quarter Q4 2025
7.1KRx
Medicaid pays / ea
$0.1554
gross reimbursed
vs
NADAC / ea
$1.1547
acquisition cost
=
Spread
−$0.9993
-87% vs cost
What Medicaid paid per ea (before rebates; includes the pharmacy’s dispensing fee) compared with NADAC — the average price pharmacies pay to buy the drug. A positive spread means Medicaid reimbursed more than the purchase price, before manufacturer rebates.
Fee-for-service vs managed care ⓘ
52% FFS 48% MCO
Fee-for-service · 16,324 Rx Managed care · 15,289 Rx
State Medicaid map
Alaska: no data reported AK Maine: no data reported ME Washington: 9,111 units · 117 per 100k residents WA Idaho: 5,074 units · 258 per 100k residents ID Montana: 1,522 units · 134 per 100k residents MT North Dakota: no data reported ND Minnesota: 4,300 units · 75.0 per 100k residents MN Wisconsin: no data reported WI Michigan: 73,044 units · 728 per 100k residents MI New York: 331 units · 1.7 per 100k residents NY Vermont: 180,030 units · 27,825 per 100k residents VT New Hampshire: 2,048 units · 146 per 100k residents NH Oregon: 596,037 units · 14,081 per 100k residents OR Nevada: 5,712 units · 179 per 100k residents NV Wyoming: no data reported WY South Dakota: no data reported SD Iowa: no data reported IA Illinois: 5,419 units · 43.2 per 100k residents IL Indiana: 78,897 units · 1,150 per 100k residents IN Ohio: 555,900 units · 4,717 per 100k residents OH Pennsylvania: 674,764 units · 5,206 per 100k residents PA New Jersey: 19,007 units · 205 per 100k residents NJ Massachusetts: 67,563 units · 965 per 100k residents MA California: 536,556 units · 1,377 per 100k residents CA Utah: no data reported UT Colorado: 249,685 units · 4,248 per 100k residents CO Nebraska: 115 units · 5.8 per 100k residents NE Missouri: no data reported MO Kentucky: 782 units · 17.3 per 100k residents KY West Virginia: 218,161 units · 12,325 per 100k residents WV Virginia: 20,937 units · 240 per 100k residents VA Maryland: 13,252 units · 214 per 100k residents MD Connecticut: 169,580 units · 4,688 per 100k residents CT Rhode Island: no data reported RI Arizona: 13,874 units · 187 per 100k residents AZ New Mexico: 188 units · 8.9 per 100k residents NM Kansas: 1,698 units · 57.8 per 100k residents KS Arkansas: no data reported AR Tennessee: 12,682 units · 178 per 100k residents TN North Carolina: 30,565 units · 282 per 100k residents NC South Carolina: 2,055 units · 38.2 per 100k residents SC Delaware: 47,753 units · 4,632 per 100k residents DE Oklahoma: 109,327 units · 2,697 per 100k residents OK Louisiana: 3,029 units · 66.2 per 100k residents LA Mississippi: no data reported MS Alabama: no data reported AL Georgia: 1,273 units · 11.5 per 100k residents GA D.C.: 5,171 units · 762 per 100k residents DC Hawaii: no data reported HI Texas: 3,645,171 units · 11,950 per 100k residents TX Florida: no data reported FL
Units reimbursed · per 100k residents
1.727,825
gray = no data reported ⓘ
Colors are per 100,000 residents, so big states don’t automatically dominate. Tap or hover a state for its actual totals.
Tap or hover a state
…for its Medicaid breakdown
🏆 Top states by units · per 100k residents
1 Vermont 27,825 /100k
2 Oregon 14,081 /100k
3 West Virginia 12,325 /100k
4 Texas 11,950 /100k
5 Pennsylvania 5,206 /100k
6 Ohio 4,717 /100k
7 Connecticut 4,688 /100k
8 Delaware 4,632 /100k
National units — by quarter
💵 About the dollar figures: “reimbursed” is what Medicaid paid pharmacies before confidential manufacturer rebates, so the program’s real net cost is lower than these numbers. Fee-for-service and managed-care claims are combined unless split above. Source: CMS State Drug Utilization Data; per-100k rates use 2023 Census population estimates.

💊 Medicaid utilization by pack size

Medicaid (SDUD) totals over the four most recent reported quarters for every package size of this drug — handy when a specific package (e.g. a starter/titration pack) carries little or no Medicaid volume on its own.
100 packets this page00904-6931-81 31,613 Rx · $1,143,652
30 packets00904-6931-76 27,415 Rx · $1,108,322
14 packets00904-6931-26 8,914 Rx · $310,043
17 gs00904-6931-86 1,941 Rx · $18,158
Drug total (last 4 qtrs): 69,883 Rx · 13,758,822 units · $2,580,175 gross reimbursed
Tap a pack size to open its page. Source: CMS State Drug Utilization Data, last 4 quarters.

🔬 Reported adverse events (FAERS)

Read carefully: FAERS reports are voluntary and unverified. Counts are not incidence, do not establish causation, are subject to reporting bias, and cannot be used to compare one drug to another. Shown for signal context only. Reports for Polyethylene Glycol 3350 — the ingredient across all brands.

Top reported reactions

Diarrhoea7,484
Nausea6,227
Constipation5,524
Fatigue5,024
Vomiting4,309
Pain3,230
Headache3,070

Age at onset

Neonate17
Infant174
Child1,375
Adolescent450
Adult10,375
Elderly15,211

Reporter sex

0 reports

Serious outcomes

Hospitalization23,087
Death6,667
Life-threatening2,288
Disabling1,827
Reports over time (by year) — tap or hover for the count & year
2019 2021 2023 2026 7,550 0
Most recent year is provisional (FAERS lags ~3 months).
Where does this data come from?
Adverse-event reports from the FDA Adverse Event Reporting System (FAERS) via openFDA. FAERS reports are voluntary and unverified — counts are not incidence and don’t establish causation.

📦 Packaging — all sizes for this product

Package NDCDescription Per unit Per pack Marketing startStatus
00904-6931-26 14 PACKET in 1 CARTON (0904-6931-26) / 17 g in 1 PACKET $1.15 / ea $16.17 2019-06-30 Active
00904-6931-76 30 PACKET in 1 CARTON (0904-6931-76) / 17 g in 1 PACKET $1.15 / ea $34.64 2019-06-30 Active
00904-6931-81 You're viewing this 100 PACKET in 1 CARTON (0904-6931-81) / 17 g in 1 PACKET $1.15 / ea $115.47 2019-06-30 Active
00904-6931-86 17 g in 1 PACKET (0904-6931-86) $1.15 / ea $1.15 2019-06-30 Active

This pack effectively ties for the lowest per-ea cost of the 4 priced pack sizes ($1.15 NADAC).

In Medicaid, this is the most-dispensed pack of this product — about 45% of fills over the last four reported quarters. See all packs ↓

Pack size FAQ

What quantity is in NDC 00904-6931-81?
NDC 00904-6931-81 is listed by the FDA — 100 packet in 1 carton / 17 g in 1 packet.
What NDC number is used to bill for this package of Polyethylene glycol 3350 3350 17 g/17g Powder, For Solution?
Bill NDC 00904-6931-81 — the 11-digit billing format is 00904693181. Pharmacy and medical claims use the 11-digit form; the FDA label may print a shorter form of the same code.

Prices are the latest CMS NADAC pharmacy acquisition cost per NDC; per-pack figures are per-unit × pack quantity, shown only when the pack is denominated in the same measure NADAC prices.

📄 FDA label — Drug Facts FDA SPL

The complete FDA label for this product — the official Drug Facts labeling, verbatim, section by section. Jump with a chip, search within the label, or expand everything.
🎯 Indications and Usage ⏱️ Dosage and Administration ⚠️ Warnings 📦 Storage and Handling 🧪 Active Ingredient 🧪 Inactive Ingredients 🎯 Purpose
🎯 Indications and Usage 15 words ▾

Use relieves occasional constipation (irregularity) generally produces a bowel movement in 1 to 3 days

⏱️ Dosage and Administration 93 words ▾

Directions do not take more than directed unless advised by your doctor adults and children 17 years of age and older: use once a day stir and dissolve one packet of powder (17 g) in any 4 to 8 ounces of beverage (cold, hot or room temperature) then drink do not combine with starch-based thickeners used for difficulty swallowing ensure that the powder is fully dissolved before drinking do not drink if there are any clumps do not use more than 7 days children 16 years of age or under: ask a doctor

⚠️ Warnings 157 words ▾

Warnings Allergy alert: Do not use if you are allergic to polyethylene glycol Do not use if you have kidney disease, except under the advice and supervision of a doctor Ask a doctor before use if you have nausea, vomiting or abdominal pain a sudden change in bowel habits that lasts over 2 weeks irritable bowel syndrome Ask a doctor or pharmacist before use if you are taking a prescription drug When using this product you may have loose, watery, more frequent stools Stop use and ask a doctor if you get diarrhea you need to use a laxative for longer than 1 week you have rectal bleeding or your nausea, bloating, cramping or abdominal pain gets worse.

These may be signs of a serious condition. If pregnant or breast-feeding, ask a health professional before use. Keep out of reach of children.

In case of overdose, get medical help or contact a Poison Control Center right away.

📦 Storage and Handling 20 words ▾

Other information store at 20° - 25°C (68° - 77°F) tamper-evident: do not use if foil is open or broken

🧪 Active Ingredient 10 words ▾

Active ingredient (in each dose) Polyethylene Glycol 3350, 17 g

🧪 Inactive Ingredients 3 words ▾

Inactive ingredients none

🎯 Purpose 3 words ▾

Purpose Osmotic Laxative

Source: FDA Structured Product Labeling, mirrored from DailyMed / openFDA. Prefer the government’s original formatting? View this label on DailyMed ↗
← 00904-6929-61 · Major 00904-6935-61 · Major →
For educational and professional reference only — not medical advice. Pricing reflects published NADAC and CMS ASP (free public data) and may differ from your acquisition cost; always verify before billing or dispensing.