nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac]
nepafenac
RxCUI: 603978
What the CMS Formulary Data Shows for nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac]
Per the CMS 2026 Part D formulary file, nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] (RxNorm concept RXCUI 603978, generic name nepafenac) appears on 4 distinct formulary files spanning 21 Medicare Part D plan offerings - 0.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.
Real-world access to nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 50% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 28,476 Part D beneficiaries filled nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] 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 1 MG/ML Ophthalmic Suspension [Nevanac] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 21
- Coverage rate
- 0.4%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 50% of formularies
2023 Medicare Spending
- Beneficiaries
- 28,476
- Total spending
- $20,449,838
- Avg per beneficiary
- $718.14
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac]
21 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | No | $0 | CA |
| HAP Medicare Explore (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $0 | MI |
| HAP Medicare Prime (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $0 | MI |
| HAP Medicare Connect (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| HAP Medicare Superior (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| Henry Ford Select (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $0 | MI |
| FHCP Medicare Classic (HMO) | FLORIDA BLUE MEDICARE, INC. | T3 | No | $0 | FL |
| HAP Member Assist (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | HEALTH ALLIANCE PLAN OF MICHIGAN | T3 | No | $13.50 | MI |
| HAP Senior Plus (PPO) | ALLIANCE HEALTH AND LIFE INSURANCE COMPANY | T3 | No | $42.60 | MI |
| FHCP Medicare Rx Plus (HMO-POS) | FLORIDA BLUE MEDICARE, INC. | T3 | No | $49.00 | FL |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T4 | No | $0 | PR |
Frequently Asked Questions
Is nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] covered by Medicare Part D?
Yes, nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] is covered by 21 Medicare Part D plans (0.4% of all Part D formularies).
What tier is nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] on Medicare Part D plans?
nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] averages Tier 3 across Part D plans, ranging from Tier 2 to Tier 4.
Does nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] require prior authorization?
0% of Part D formularies require prior authorization for nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac]. Step therapy: 0%. Quantity limits: 50%.
How much does Medicare spend on nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac]?
In 2023, total Medicare Part D spending on nepafenac 1 MG/ML Ophthalmic Suspension [Nevanac] 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.