Medicare Part D coverage · loteprednol etabonate · RxCUI 1312627
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] is covered by 791 Medicare Part D plans (15.7% of enrollable products), averaging Tier 3.8, with prior authorization required on 0% of covering formularies.
- 15.7%
- Plan coverage
- 791
- Plans covering
- T3.8
- Avg tier
- 0%
- Prior auth required
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 - 15.7% 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
- 15.7%
- 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 |
Show the next 30 plans
Showing top 50 of 98 plans.
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 (15.7% 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.
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.
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