Medicare Part D coverage · loteprednol etabonate · RxCUI 213263
loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax]
Per the CMS 2026 Part D formulary file, loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] is covered by 775 Medicare Part D plans (15.3% of enrollable products), averaging Tier 4, with prior authorization required on 0% of covering formularies.
- 15.3%
- Plan coverage
- 775
- Plans covering
- T4
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax]
Per the CMS 2026 Part D formulary file, loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] (RxNorm concept RXCUI 213263, generic name loteprednol etabonate) appears on 4 distinct formulary files spanning 775 Medicare Part D plan offerings - 15.3% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.
Real-world access to loteprednol etabonate 5 MG/ML Ophthalmic Suspension [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 5 MG/ML Ophthalmic Suspension [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 5 MG/ML Ophthalmic Suspension [Lotemax] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 775
- Coverage rate
- 15.3%
- Tier range
- Tier 4, Non-Preferred
- 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 5 MG/ML Ophthalmic Suspension [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 5 MG/ML Ophthalmic Suspension [Lotemax]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
Show the next 30 plans
Showing top 50 of 98 plans.
Frequently Asked Questions
Is loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] covered by Medicare Part D?
Yes, loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] is covered by 775 Medicare Part D plans (15.3% of all Part D formularies).
What tier is loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] on Medicare Part D plans?
loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax] require prior authorization?
0% of Part D formularies require prior authorization for loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on loteprednol etabonate 5 MG/ML Ophthalmic Suspension [Lotemax]?
In 2023, total Medicare Part D spending on loteprednol etabonate 5 MG/ML Ophthalmic Suspension [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.
Closest average formulary tier
- dihydroergotamine mesylate 0.5 MG/ACTUAT Metered Dose Nasal Spray T4
- 0.5 ML darbepoetin alfa 0.2 MG/ML Prefilled Syringe [Aranesp] T4
- amoxicillin 250 MG / omeprazole 10 MG / rifabutin 12.5 MG Delayed Release Oral Capsule [Talicia] T4
- timolol hemihydrate 5 MG/ML Ophthalmic Solution [Betimol] T4
- deflazacort 18 MG Oral Tablet [Jaythari] T4
- bepotastine besilate 15 MG/ML Ophthalmic Solution [Bepreve] T4