Medicare Part D coverage · 0.4 · RxCUI 2572293
0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]
Per the CMS 2026 Part D formulary file, 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] is covered by 3,004 Medicare Part D plans (59.5% of enrollable products), averaging Tier 2.7, with prior authorization required on 0% of covering formularies.
- 59.5%
- Plan coverage
- 3,004
- Plans covering
- T2.7
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]
Per the CMS 2026 Part D formulary file, 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] (RxNorm concept RXCUI 2572293, generic name 0.4) appears on 172 distinct formulary files spanning 3,004 Medicare Part D plan offerings - 59.5% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 3, with a cross-plan average of Tier 2.7.
Real-world access to 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 51.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 492,479 Part D beneficiaries filled 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] in 2023, with total plan-and-beneficiary spending of $1,501,664,198 and an average per-beneficiary annual cost of $3,049.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] today.
Coverage Details
- Formularies covering
- 172
- Plans covering
- 3,004
- Coverage rate
- 59.5%
- Tier range
- Tier 1 – Tier 3
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 51.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 492,479
- Total spending
- $1,501,664,198
- Avg per beneficiary
- $3,049.19
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
| AARP Medicare Rx Saver from UHC (PDP) | Unitedhealthcare INS. Co. & UHC INS. Co. OF NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
Show the next 30 plans
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | No | $4.80 | TX |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | No | $5.00 | OK |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $13.10 | PA |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $17.60 | PA |
| Elderplan For Medicaid Beneficiaries (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $22.70 | NY |
| VIVA Medicare Extra Value (HMO D-SNP) | Viva Health, Inc. | T1 | No | $27.70 | AL |
Showing top 50 of 95 plans.
Frequently Asked Questions
Is 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] covered by Medicare Part D?
Yes, 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] is covered by 3,004 Medicare Part D plans (59.5% of all Part D formularies).
What tier is 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] on Medicare Part D plans?
0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 3.
Does 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] require prior authorization?
0% of Part D formularies require prior authorization for 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]. Step therapy: 0%. Quantity limits: 51.7%.
How much does Medicare spend on 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]?
In 2023, total Medicare Part D spending on 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis] was $1,501,664,198, covering 492,479 beneficiaries. The average spend per beneficiary was $3,049.19.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- abacavir 300 MG Oral Tablet T2.7
- escitalopram 1 MG/ML Oral Solution T2.7
- riluzole 50 MG Oral Tablet T2.7
- 168 HR clonidine 0.00417 MG/HR Transdermal System T2.7
- sodium zirconium cyclosilicate 5000 MG Powder for Oral Suspension [Lokelma] T2.7
- 1000 ML glucose 50 MG/ML / potassium chloride 0.02 MEQ/ML / sodium chloride 2.25 MG/ML Injection T2.7
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA