brimonidine 0.0033 MG/MG Topical Gel
brimonidine
RxCUI: 1437707
What the CMS Formulary Data Shows for brimonidine 0.0033 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, brimonidine 0.0033 MG/MG Topical Gel (RxNorm concept RXCUI 1437707, generic name brimonidine) appears on 6 distinct formulary files spanning 36 Medicare Part D plan offerings - 0.7% 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 3.5.
Real-world access to brimonidine 0.0033 MG/MG Topical Gel depends on utilization management as much as tier placement: 50% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 573,214 Part D beneficiaries filled brimonidine 0.0033 MG/MG Topical Gel in 2023, with total plan-and-beneficiary spending of $88,900,177 and an average per-beneficiary annual cost of $155.09. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry brimonidine 0.0033 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 6
- Plans covering
- 36
- Coverage rate
- 0.7%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 573,214
- Total spending
- $88,900,177
- Avg per beneficiary
- $155.09
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering brimonidine 0.0033 MG/MG Topical Gel
36 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T1 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T1 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $0 | MI |
| HAP Member Assist (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T1 | Yes | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T1 | Yes | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | HEALTH ALLIANCE PLAN OF MICHIGAN | T1 | Yes | $13.50 | MI |
| HAP Senior Plus (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T1 | Yes | $42.60 | MI |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $0 | WI |
| PacificSource Medicare Essentials Rx 27 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| PacificSource Dual Care Alliance (HMO D-SNP) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $0 | OR |
| Samaritan Dual Advantage (HMO D-SNP) | SAMARITAN HEALTH PLANS, INC. | T4 | Yes | $10.50 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $19.00 | ID |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $21.10 | WI |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $29.10 | OR |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $38.60 | WI |
| Independent Health's Assure Advantage (HMO C-SNP) | INDEPENDENT HEALTH ASSOCIATION, INC. | T4 | No | $46.50 | NY |
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $52.00 | ID |
| Independent Health's Medicare Family Choice (HMO I-SNP) | INDEPENDENT HEALTH ASSOCIATION, INC. | T4 | No | $58.80 | NY |
| PacificSource Medicare Essentials Rx 41 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $69.30 | OR |
| PacificSource Medicare Explorer Rx 4 (PPO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $88.70 | OR |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | Yes | $92.80 | WI |
| PacificSource Medicare Essentials Rx 6 (HMO) | PACIFICSOURCE COMMUNITY HEALTH PLANS | T4 | No | $105.90 | OR |
| Independent Health's Encompass 65 RED 043 (HMO) | INDEPENDENT HEALTH ASSOCIATION, INC. | T4 | No | $190.00 | NY |
Frequently Asked Questions
Is brimonidine 0.0033 MG/MG Topical Gel covered by Medicare Part D?
Yes, brimonidine 0.0033 MG/MG Topical Gel is covered by 36 Medicare Part D plans (0.7% of all Part D formularies).
What tier is brimonidine 0.0033 MG/MG Topical Gel on Medicare Part D plans?
brimonidine 0.0033 MG/MG Topical Gel averages Tier 3.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does brimonidine 0.0033 MG/MG Topical Gel require prior authorization?
50% of Part D formularies require prior authorization for brimonidine 0.0033 MG/MG Topical Gel. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on brimonidine 0.0033 MG/MG Topical Gel?
In 2023, total Medicare Part D spending on brimonidine 0.0033 MG/MG Topical Gel was $88,900,177, covering 573,214 beneficiaries. The average spend per beneficiary was $155.09.
Read our methodology - how this data is sourced, computed, and verified.