Medicare Part D coverage · loteprednol etabonate · RxCUI 311382
loteprednol etabonate 5 MG/ML Ophthalmic Suspension
Per the CMS 2026 Part D formulary file, loteprednol etabonate 5 MG/ML Ophthalmic Suspension is covered by 3,240 Medicare Part D plans (64.1% of enrollable products), averaging Tier 2.5, with prior authorization required on 0% of covering formularies.
- 64.1%
- Plan coverage
- 3,240
- Plans covering
- T2.5
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for loteprednol etabonate 5 MG/ML Ophthalmic Suspension
Per the CMS 2026 Part D formulary file, loteprednol etabonate 5 MG/ML Ophthalmic Suspension (RxNorm concept RXCUI 311382, generic name loteprednol etabonate) appears on 170 distinct formulary files spanning 3,240 Medicare Part D plan offerings - 64.1% 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 2.5.
Real-world access to loteprednol etabonate 5 MG/ML Ophthalmic Suspension depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0.6% require step therapy. 31.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,483 Part D beneficiaries filled loteprednol etabonate 5 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 5 MG/ML Ophthalmic Suspension today.
Coverage Details
- Formularies covering
- 170
- Plans covering
- 3,240
- Coverage rate
- 64.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0.6% of formularies
- Quantity limits
- 31.2% 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 5 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 |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $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 |
Show the next 30 plans
| 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 |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| 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 |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | No | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | No | $4.80 | FL |
| SECUR Enhanced (HMO I-SNP) | Secur 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 |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | No | $8.80 | MI |
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | No | $8.90 | AR |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | No | $10.50 | OR, WA |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | No | $10.50 | OR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is loteprednol etabonate 5 MG/ML Ophthalmic Suspension covered by Medicare Part D?
Yes, loteprednol etabonate 5 MG/ML Ophthalmic Suspension is covered by 3,240 Medicare Part D plans (64.1% of all Part D formularies).
What tier is loteprednol etabonate 5 MG/ML Ophthalmic Suspension on Medicare Part D plans?
loteprednol etabonate 5 MG/ML Ophthalmic Suspension averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does loteprednol etabonate 5 MG/ML Ophthalmic Suspension require prior authorization?
0% of Part D formularies require prior authorization for loteprednol etabonate 5 MG/ML Ophthalmic Suspension. Step therapy: 0.6%. Quantity limits: 31.2%.
How much does Medicare spend on loteprednol etabonate 5 MG/ML Ophthalmic Suspension?
In 2023, total Medicare Part D spending on loteprednol etabonate 5 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
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA