pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution
pilocarpine hydrochloride
RxCUI: 1000897
What the CMS Formulary Data Shows for pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution
Per the CMS 2026 Part D formulary file, pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution (RxNorm concept RXCUI 1000897, generic name pilocarpine hydrochloride) appears on 330 distinct formulary files spanning 5,067 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.3.
Real-world access to pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0.6% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,595 Part D beneficiaries filled pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution in 2023, with total plan-and-beneficiary spending of $25,321,949 and an average per-beneficiary annual cost of $276.46. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution today.
Coverage Details
- Formularies covering
- 330
- Plans covering
- 5,067
- Coverage rate
- 100%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0.6% of formularies
2023 Medicare Spending
- Beneficiaries
- 91,595
- Total spending
- $25,321,949
- Avg per beneficiary
- $276.46
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution
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 |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | No | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | No | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | No | $0 | MA |
| 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 |
| 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 |
| Horizon NJ TotalCare (HMO D-SNP) | HORIZON HEALTHCARE OF NEW JERSEY, INC. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | FALLON COMMUNITY HEALTH PLAN | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | No | $0 | CA |
| PHP (HMO C-SNP) | AIDS HEALTHCARE FOUNDATION | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | COMMONWEALTH CARE ALLIANCE, INC. | T1 | No | $0 | MA |
| 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 |
| Generations Classic Rewards (HMO) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
| Generations Classic Plus (HMO) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
| Generations Chronic Care (HMO C-SNP) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
| Generations Chronic Care Savings (HMO C-SNP) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
| Generations Dual Support (HMO D-SNP) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
| Generations Dual Premier (HMO D-SNP) | GLOBALHEALTH, INC. | T1 | No | $0 | OK |
Frequently Asked Questions
Is pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution covered by Medicare Part D?
Yes, pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution is covered by 5,067 Medicare Part D plans (100% of all Part D formularies).
What tier is pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution on Medicare Part D plans?
pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution require prior authorization?
0% of Part D formularies require prior authorization for pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution. Step therapy: 0%. Quantity limits: 0.6%.
How much does Medicare spend on pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution?
In 2023, total Medicare Part D spending on pilocarpine hydrochloride 40 MG/ML Ophthalmic Solution was $25,321,949, covering 91,595 beneficiaries. The average spend per beneficiary was $276.46.
Read our methodology - how this data is sourced, computed, and verified.