loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax]
loteprednol etabonate
RxCUI: 2118539
What the CMS Formulary Data Shows for loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax]
Per the CMS 2026 Part D formulary file, loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] (RxNorm concept RXCUI 2118539, generic name loteprednol etabonate) appears on 106 distinct formulary files spanning 2,915 Medicare Part D plan offerings - 57.5% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.1.
Real-world access to loteprednol etabonate 0.0038 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. 64.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,483 Part D beneficiaries filled loteprednol etabonate 0.0038 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 0.0038 MG/MG Ophthalmic Gel [Lotemax] today.
Coverage Details
- Formularies covering
- 106
- Plans covering
- 2,915
- Coverage rate
- 57.5%
- 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
- 64.2% 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 0.0038 MG/MG Ophthalmic Gel [Lotemax]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Abilis Health Community (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $0 | KY, TN |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF FLORIDA INC | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| 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 |
| 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 |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| Alterwood Advantage Dual Value (HMO D-SNP) | ALTERWOOD ADVANTAGE, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| BlueCare Plus (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| BlueCare Plus Choice (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| BlueCare Plus Select (HMO D-SNP) | VOLUNTEER STATE HEALTH PLAN | T2 | No | $0 | TN |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T2 | No | $0 | CA |
| DualConnect (HMO D-SNP) | SANTA CLARA COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS CHOICE | T2 | No | $0 | NY |
| Leon MediExtra (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMore (HMO) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | LEON HEALTH, INC. | T2 | No | $0 | FL |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T2 | No | $51.60 | NY |
Frequently Asked Questions
Is loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] covered by Medicare Part D?
Yes, loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] is covered by 2,915 Medicare Part D plans (57.5% of all Part D formularies).
What tier is loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] on Medicare Part D plans?
loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax] require prior authorization?
0% of Part D formularies require prior authorization for loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax]. Step therapy: 0%. Quantity limits: 64.2%.
How much does Medicare spend on loteprednol etabonate 0.0038 MG/MG Ophthalmic Gel [Lotemax]?
In 2023, total Medicare Part D spending on loteprednol etabonate 0.0038 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.