loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]
loteprednol etabonate
RxCUI: 1312627
What the CMS Formulary Data Shows for loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]
Per the CMS 2026 Part D formulary file, loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] (RxNorm concept RXCUI 1312627, generic name loteprednol etabonate) appears on 5 distinct formulary files spanning 791 Medicare Part D plan offerings - 15.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 4, with a cross-plan average of Tier 3.8.
Real-world access to loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] 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 91,483 Part D beneficiaries filled loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] 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 0.005 MG/MG Ophthalmic Gel [Lotemax] today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 791
- Coverage rate
- 15.6%
- Tier range
- Tier 3 – Tier 4
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 91,483
- Total spending
- $33,190,775
- Avg per beneficiary
- $362.81
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]
2 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 | T4 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T4 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| MMM Supremo (HMO C-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Diamante Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Unico (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Elite (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Deluxe (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Dorado Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| PMC Premier Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| PMC Max (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Plenitud (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Valioso (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Combo Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Flexi Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Grandioso (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Mega Flex (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Relax Platino (HMO D-SNP) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| MMM Balance (HMO-POS) | MMM HEALTHCARE, LLC | T3 | No | $0 | PR |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T4 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T4 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T4 | No | $0 | NM |
| UHC Dual Complete AZ-S001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T4 | No | $0 | AZ |
| UHC Dual Complete AZ-Y001 (HMO-POS D-SNP) | ARIZONA PHYSICIANS IPA, INC. | T4 | No | $0 | AZ |
| UHC Dual Complete VA-Y4 (PPO D-SNP) | CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO. | T4 | No | $0 | VA |
| AARP Medicare Advantage from UHC AL-0001 (HMO-POS) | UNITEDHEALTHCARE OF THE MIDLANDS, INC. | T4 | No | $0 | AL |
| AARP Medicare Advantage from UHC CA-0002 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| UHC Sharp Medicare Advantage CA-001P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-003P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-0012 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-004P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-005P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-006P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-10 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| UHC Sharp Medicare Advantage ValueRx CA-12P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-021P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-022P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-023P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage from UHC CA-026P (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage Giveback from UHC CA-19 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage Giveback from UHC CA-20 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage Giveback from UHC CA-21 (HMO-POS) | UHC OF CALIFORNIA | T4 | No | $0 | CA |
| AARP Medicare Advantage Essentials from UHC CO-2 (HMO-POS) | UnitedHealthcare Benefits of Texas, Inc. | T4 | No | $0 | CO |
Frequently Asked Questions
Is loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] covered by Medicare Part D?
Yes, loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] is covered by 791 Medicare Part D plans (15.6% of all Part D formularies).
What tier is loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] on Medicare Part D plans?
loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] averages Tier 3.8 across Part D plans, ranging from Tier 3 to Tier 4.
Does loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] require prior authorization?
0% of Part D formularies require prior authorization for loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax]?
In 2023, total Medicare Part D spending on loteprednol etabonate 0.005 MG/MG Ophthalmic Gel [Lotemax] 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.