bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]
bromfenac
RxCUI: 1375922
What the CMS Formulary Data Shows for bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]
Per the CMS 2026 Part D formulary file, bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] (RxNorm concept RXCUI 1375922, generic name bromfenac) appears on 14 distinct formulary files spanning 435 Medicare Part D plan offerings - 8.6% 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 2.9.
Real-world access to bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] depends on utilization management as much as tier placement: 0% 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 144,112 Part D beneficiaries filled bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] in 2023, with total plan-and-beneficiary spending of $94,508,695 and an average per-beneficiary annual cost of $655.80. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] today.
Coverage Details
- Formularies covering
- 14
- Plans covering
- 435
- Coverage rate
- 8.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 144,112
- Total spending
- $94,508,695
- Avg per beneficiary
- $655.80
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Wellcare Simple (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
| Wellcare Giveback (HMO-POS) | WELLCARE OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Wellcare Simple (HMO-POS) | COORDINATED CARE OF WASHINGTON, INC. | T3 | No | $0 | WA |
| Wellcare Simple Open (PPO) | WELLCARE OF MISSISSIPPI, INC. | T3 | No | $0 | MS |
| Wellcare Simple Open (PPO) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Simple (HMO) | WELLCARE OF TEXAS, INC. | T3 | No | $0 | TX |
| Wellcare Simple Open (PPO) | WELLCARE HEALTH INSURANCE COMPANY OF AMERICA | T3 | No | $0 | AR |
| Wellcare Simple (HMO) | HEALTH NET OF ARIZONA, INC. | T3 | No | $0 | AZ |
| Wellcare Simple (HMO) | HEALTH NET OF ARIZONA, INC. | T3 | No | $0 | AZ |
| Wellcare Simple Value (HMO) | HEALTH NET OF ARIZONA, INC. | T3 | No | $0 | AZ |
| Wellcare Simple (HMO-POS) | HEALTH NET OF ARIZONA, INC. | T3 | No | $0 | NV |
| Wellcare Simple (HMO-POS) | HEALTH NET OF ARIZONA, INC. | T3 | No | $0 | NV |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T3 | No | $0 | CA |
| Wellcare Simple Focus (HMO) | HEALTH NET OF CALIFORNIA, INC. | T3 | No | $0 | CA |
| Wellcare Simple Focus (HMO) | HEALTH NET OF CALIFORNIA, INC. | T3 | No | $0 | CA |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T3 | No | $0 | CA |
| Wellcare Low Premium (HMO) | HEALTH NET OF CALIFORNIA, INC. | T3 | No | $0 | CA |
| Wellcare Simple (HMO-POS) | BUCKEYE COMMUNITY HEALTH PLAN, INC. | T3 | No | $0 | OH |
| Wellcare Low Premium (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T3 | No | $0 | NJ |
| Wellcare Giveback (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T3 | No | $0 | NJ |
| Wellcare Simple (HMO-POS) | WELLCARE HEALTH PLANS OF NEW JERSEY, INC. | T3 | No | $0 | NJ |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO) | Sunshine State Health Plan, Inc. | T3 | No | $0 | FL |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Simple (HMO-POS) | WELLCARE OF GEORGIA, INC. | T3 | No | $0 | GA |
| Wellcare Giveback (HMO-POS) | NEBRASKA TOTAL CARE, INC. | T3 | No | $0 | NE |
| Wellcare Simple (HMO-POS) | NEBRASKA TOTAL CARE, INC. | T3 | No | $0 | NE |
| Wellcare Simple Open (PPO) | NEBRASKA TOTAL CARE, INC. | T3 | No | $0 | NE |
| Wellcare Low Premium (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | MS |
| Wellcare Simple Preferred (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | AR |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | MS |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | MS |
| Wellcare Simple (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | TN |
| Wellcare Simple Value (HMO-POS) | HARMONY HEALTH PLAN, INC. | T3 | No | $0 | IL |
| Wellcare Simple (HMO-POS) | HOME STATE HEALTH PLAN, INC. | T3 | No | $0 | MO |
| Wellcare Simple (HMO-POS) | WELLCARE OF IOWA, INC. | T3 | No | $0 | IA |
| Wellcare Simple Open (PPO) | WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC. | T3 | No | $0 | CT |
| Wellcare Giveback Open (PPO) | WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC. | T3 | No | $0 | CT |
| Wellcare Simple Open (PPO) | WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC. | T3 | No | $0 | NC |
| Wellcare Simple Open (PPO) | MERIDIAN HEALTH PLAN OF MICHIGAN, INC. | T3 | No | $0 | MI |
Frequently Asked Questions
Is bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] covered by Medicare Part D?
Yes, bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] is covered by 435 Medicare Part D plans (8.6% of all Part D formularies).
What tier is bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] on Medicare Part D plans?
bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] require prior authorization?
0% of Part D formularies require prior authorization for bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa]?
In 2023, total Medicare Part D spending on bromfenac 0.7 MG/ML Ophthalmic Solution [Prolensa] was $94,508,695, covering 144,112 beneficiaries. The average spend per beneficiary was $655.80.
Read our methodology - how this data is sourced, computed, and verified.