OBJECTIVES: Joint guidelines recommend colorectal cancer (CRC) screening every 10 years in average-risk adults beginning at age 50 years including colonoscopy (CSPY) where proper bowel preparation is critical for quality screening. The aim of our analysis was to quantify the budget impact on US payers of introducing a dual-acting osmotic and stimulant laxative for bowel cleansing, sodium picosulfate/magnesium citrate ( P/MC) in individuals 65 years and older.  METHODS: A decision analytic model was developed to estimate the impact on direct medical costs of P/MC utilization in CRC screening by CSPY (2% and 12% in years one and three, respectively). Standard clinical practice was represented through a decision tree based on clinical guidelines and included utilization of currently prescribed bowel cleansing products (MoviPrep, HalfLytely, SuPrep, 4L PEG). Data from RCTs were used to quantify the adequacy of bowel cleansing. Prep costs were based on 2012 wholesale acquisition costs. Costs of complete, incomplete and repeat colonoscopies were obtained from Medicare claims analyses. RESULTS: For every 100,000 individuals 65 years of age and older who undergo colonoscopy, the use of P/MC demonstrated cost neutrality when used by 2% of subjects, yielding annual incremental savings of $86,555 ($213,016,329 before introduction vs. $212,929,775 after introduction). If P/MC use increases to 12% in year three, the annual estimated incremental savings per 100,000 cases increased to $333,846. Cost savings are mainly due to a reduction in repeat colonoscopies (-$439,904 year one and -$572,792 year three). One-way sensitivity analysis demonstrated the model to be most sensitive to P/MC drug cost and adequacy of cleansing when using generic 4L PEG. CONCLUSIONS: The introduction of P/MC into CRC screening practice in a 65 year and older population is cost neutral from the US payer perspective with moderate cost savings which becomes greater with increased utilization.