Medicare Part D coverage · loteprednol etabonate · RxCUI 311381
loteprednol etabonate 2 MG/ML Ophthalmic Suspension
Per the CMS 2026 Part D formulary file, loteprednol etabonate 2 MG/ML Ophthalmic Suspension is covered by 2,455 Medicare Part D plans (48.6% of enrollable products), averaging Tier 2.5, with prior authorization required on 0.8% of covering formularies.
- 48.6%
- Plan coverage
- 2,455
- Plans covering
- T2.5
- Avg tier
- 0.8%
- Prior auth required
What the CMS Formulary Data Shows for loteprednol etabonate 2 MG/ML Ophthalmic Suspension
Per the CMS 2026 Part D formulary file, loteprednol etabonate 2 MG/ML Ophthalmic Suspension (RxNorm concept RXCUI 311381, generic name loteprednol etabonate) appears on 124 distinct formulary files spanning 2,455 Medicare Part D plan offerings - 48.6% 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 2.5.
Real-world access to loteprednol etabonate 2 MG/ML Ophthalmic Suspension depends on utilization management as much as tier placement: 0.8% of covering formularies require prior authorization. 41.1% require step therapy. 1.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,483 Part D beneficiaries filled loteprednol etabonate 2 MG/ML Ophthalmic Suspension in 2023, with total plan-and-beneficiary spending of $33,190,775 and an average per-beneficiary annual cost of $362.81. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry loteprednol etabonate 2 MG/ML Ophthalmic Suspension today.
Coverage Details
- Formularies covering
- 124
- Plans covering
- 2,455
- Coverage rate
- 48.6%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0.8% of formularies
- Step therapy required
- 41.1% of formularies
- Quantity limits
- 1.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 91,483
- Total spending
- $33,190,775
- Avg per beneficiary
- $362.81
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering loteprednol etabonate 2 MG/ML Ophthalmic Suspension
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | Yes | $0 | CA |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| DualConnect (HMO D-SNP) | Santa Clara County Health Authority | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
Show the next 30 plans
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| 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 |
| 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 |
| Leon MediExtra (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | No | $32.70 | WV |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | No | $35.20 | CO |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $35.90 | KY, TN |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | No | $36.20 | NC |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | No | $38.40 | IN, MD, OH |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $40.00 | NJ |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is loteprednol etabonate 2 MG/ML Ophthalmic Suspension covered by Medicare Part D?
Yes, loteprednol etabonate 2 MG/ML Ophthalmic Suspension is covered by 2,455 Medicare Part D plans (48.6% of all Part D formularies).
What tier is loteprednol etabonate 2 MG/ML Ophthalmic Suspension on Medicare Part D plans?
loteprednol etabonate 2 MG/ML Ophthalmic Suspension averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does loteprednol etabonate 2 MG/ML Ophthalmic Suspension require prior authorization?
0.8% of Part D formularies require prior authorization for loteprednol etabonate 2 MG/ML Ophthalmic Suspension. Step therapy: 41.1%. Quantity limits: 1.6%.
How much does Medicare spend on loteprednol etabonate 2 MG/ML Ophthalmic Suspension?
In 2023, total Medicare Part D spending on loteprednol etabonate 2 MG/ML Ophthalmic Suspension was $33,190,775, covering 91,483 beneficiaries. The average spend per beneficiary was $362.81.
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
- ethosuximide 50 MG/ML Oral Solution T2.5
- Sugar-Free cholestyramine resin 4000 MG Powder for Oral Suspension T2.5
- 24 HR niacin 500 MG Extended Release Oral Tablet T2.5
- fluocinolone acetonide 0.00025 MG/MG Topical Ointment T2.5
- theophylline 100 MG Extended Release Oral Tablet T2.5
- amiodarone hydrochloride 100 MG Oral Tablet T2.5
Similar prior-authorization rate
- 1000 ML glucose 25 MG/ML / sodium chloride 4.5 MG/ML Injection 0.8% PA
- sodium chloride 0.154 MEQ/ML Irrigation Solution 0.8% PA
- 4 ML bumetanide 0.25 MG/ML Injection 0.8% PA
- 500 ML glucose 50 MG/ML / sodium chloride 2 MG/ML Injection 0.8% PA
- 3 ML insulin lispro-aabc 200 UNT/ML Pen Injector [Lyumjev] 0.8% PA
- plecanatide 3 MG Oral Tablet [Trulance] 0.8% PA