acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr]

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acoltremon

RxCUI: 2716826

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
0.1%
Plan Coverage
4
Plans Covering
T2.5
Avg Tier
100%
Prior Auth Required

What the CMS Formulary Data Shows for acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr]

Per the CMS 2026 Part D formulary file, acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] (RxNorm concept RXCUI 2716826, generic name acoltremon) appears on 2 distinct formulary files spanning 4 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.5.

Real-world access to acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.

Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] today.

Coverage Details

Formularies covering
2
Plans covering
4
Coverage rate
0.1%
Tier range
Tier 1 – Tier 4
Average tier
Tier 3, Preferred Brand

Restrictions

Prior authorization required
100% of formularies
Step therapy required
0% of formularies
Quantity limits
100% of formularies

Tier Distribution Across Plans

1 plans
Tier 1, Preferred Generic
3 plans
Tier 4, Non-Preferred

Medicare Advantage Plans (MA-PD) Covering acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr]

4 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
NaviCare (HMO D-SNP) FALLON COMMUNITY HEALTH PLAN T1 Yes $0 MA
Fallon Medicare Plus Orange (HMO) FALLON COMMUNITY HEALTH PLAN T4 Yes $0 MA
Fallon Medicare Plus Green (HMO) FALLON COMMUNITY HEALTH PLAN T4 Yes $56.40 MA
Fallon Medicare Plus Blue (HMO) FALLON COMMUNITY HEALTH PLAN T4 Yes $72.10 MA

Frequently Asked Questions

Is acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] covered by Medicare Part D?

Yes, acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] is covered by 4 Medicare Part D plans (0.1% of all Part D formularies).

What tier is acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] on Medicare Part D plans?

acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.

Does acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr] require prior authorization?

100% of Part D formularies require prior authorization for acoltremon 0.03 MG/ML Ophthalmic Solution [Tryptyr]. Step therapy: 0%. Quantity limits: 100%.

Read our methodology - how this data is sourced, computed, and verified.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial