nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]
nepafenac
RxCUI: 1365866
What the CMS Formulary Data Shows for nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]
Per the CMS 2026 Part D formulary file, nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] (RxNorm concept RXCUI 1365866, generic name nepafenac) appears on 124 distinct formulary files spanning 2,492 Medicare Part D plan offerings - 49.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.9.
Real-world access to nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 16.1% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 28,476 Part D beneficiaries filled nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] in 2023, with total plan-and-beneficiary spending of $20,449,838 and an average per-beneficiary annual cost of $718.14. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] today.
Coverage Details
- Formularies covering
- 124
- Plans covering
- 2,492
- Coverage rate
- 49.2%
- 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
- 16.1% of formularies
2023 Medicare Spending
- Beneficiaries
- 28,476
- Total spending
- $20,449,838
- Avg per beneficiary
- $718.14
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]
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 | T3 | No | No | $0 | - |
| AARP Medicare Rx Preferred from UHC (PDP) | UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]
98 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| 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 |
| 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 |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | HCSC INSURANCE SERVICES COMPANY | T1 | No | $4.80 | TX |
| 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 |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS INSURANCE COMPANY | T1 | No | $5.00 | OK |
| 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 |
| 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 |
| Valor Health Plan (HMO I-SNP) | TSG GUARD, INC. | T1 | No | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | WEST VIRGINIA SENIOR ADVANTAGE, INC. | T1 | No | $32.70 | WV |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| Abilis Health (HMO I-SNP) | SIGNATURE ADVANTAGE, LLC | T1 | No | $35.90 | KY, TN |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP INC. | T1 | No | $38.40 | IN, MD, OH |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK | T1 | No | $58.80 | NY |
| 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 |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS CHOICE | T2 | No | $51.60 | NY |
| UHC Dual Complete IA-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | IA |
| UHC Dual Complete MO-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | MO |
| UHC Dual Complete NE-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | NE |
| UHC Dual Complete KS-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | KS |
| UHC Dual Complete MO-S3 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | MO |
| UHC Dual Complete KS-Q1 (HMO-POS D-SNP) | UNITEDHEALTHCARE OF WISCONSIN, INC. | T3 | No | $0 | KS |
| UHC Dual Complete TN-S001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | No | $0 | TN |
| UHC Dual Complete TN-Y001 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | No | $0 | TN |
| UHC Dual Complete TN-Y2 (HMO-POS D-SNP) | UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC. | T3 | No | $0 | TN |
| AARP Medicare Advantage from UHC MI-0001 (PPO) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | No | $0 | MI |
| UHC Dual Complete NM-Y1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | No | $0 | NM |
| UHC Dual Complete NM-S1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | No | $0 | NM |
| UHC Dual Complete NM-V1 (PPO D-SNP) | UNITEDHEALTHCARE INSURANCE COMPANY | T3 | No | $0 | NM |
Frequently Asked Questions
Is nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] covered by Medicare Part D?
Yes, nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] is covered by 2,492 Medicare Part D plans (49.2% of all Part D formularies).
What tier is nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] on Medicare Part D plans?
nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 4.
Does nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] require prior authorization?
0% of Part D formularies require prior authorization for nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]. Step therapy: 0%. Quantity limits: 16.1%.
How much does Medicare spend on nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro]?
In 2023, total Medicare Part D spending on nepafenac 3 MG/ML Ophthalmic Suspension [Ilevro] was $20,449,838, covering 28,476 beneficiaries. The average spend per beneficiary was $718.14.
Read our methodology - how this data is sourced, computed, and verified.