Medicare Part D coverage · pilocarpine hydrochloride · RxCUI 2584552
pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution
Per the CMS 2026 Part D formulary file, pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution is covered by 262 Medicare Part D plans (5.2% of enrollable products), averaging Tier 2.3, with prior authorization required on 13.6% of covering formularies.
- 5.2%
- Plan coverage
- 262
- Plans covering
- T2.3
- Avg tier
- 13.6%
- Prior auth required
What the CMS Formulary Data Shows for pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution
Per the CMS 2026 Part D formulary file, pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution (RxNorm concept RXCUI 2584552, generic name pilocarpine hydrochloride) appears on 22 distinct formulary files spanning 262 Medicare Part D plan offerings - 5.2% 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 2.3.
Real-world access to pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution depends on utilization management as much as tier placement: 13.6% of covering formularies require prior authorization. 0% require step therapy. 18.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,595 Part D beneficiaries filled pilocarpine hydrochloride 12.5 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 12.5 MG/ML Ophthalmic Solution today.
Coverage Details
- Formularies covering
- 22
- Plans covering
- 262
- Coverage rate
- 5.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 13.6% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 18.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 91,595
- Total spending
- $25,321,949
- Avg per beneficiary
- $276.46
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution
9 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
| HealthSpring Assurance Rx (PDP) | Medco Containment Life AND Medco Containment NY | T3 | No | No | $0 | - |
Medicare Advantage Plans (MA-PD) Covering pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution
91 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| DrMax (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrSelect (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrSelect-CFL (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| DrElite-SFL (HMO) | Doctors Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Troy Medicare (HMO) | Troy Health, Inc. | T2 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Troy Health, Inc. | T2 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | Contra Costa County Medical Service DBA Contra Costa Health | T2 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | Vista Health Plan, Inc. | T2 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Vista Health Plan, Inc. | T2 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | Select Health OF South Carolina, Inc. | T2 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T2 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T2 | No | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Florida, Inc. | T2 | No | $0 | FL |
Show the next 30 plans
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Louisiana, Inc. | T2 | No | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas North Carolina, Inc. | T2 | No | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Michigan, Inc. | T2 | No | $0 | MI |
| CareOregon Advantage Plus (HMO D-SNP) | Health Plan OF Careoregon, Inc. | T2 | No | $0 | OR |
| DrFlex (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $1.10 | FL |
| DrPlus (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T2 | No | $4.80 | FL |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T3 | No | $0 | AZ |
| HealthSpring Alliance (HMO) | Bravo Health Pennsylvania, Inc. | T3 | No | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | Bravo Health Pennsylvania, Inc. | T3 | No | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | Bravo Health Pennsylvania, Inc. | T3 | No | $0 | AZ |
| HealthSpring Preferred GA (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | MO |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | MO |
| HealthSpring Premier (HMO-POS) | Healthspring Life & Health Insurance Company, Inc. | T3 | No | $0 | UT |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | NM |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | OH |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | OH |
| HealthSpring Preferred Savings (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred (HMO) | Healthspring Healthcare OF Colorado, Inc. | T3 | No | $0 | CO |
Showing top 50 of 91 plans.
Frequently Asked Questions
Is pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution covered by Medicare Part D?
Yes, pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution is covered by 262 Medicare Part D plans (5.2% of all Part D formularies).
What tier is pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution on Medicare Part D plans?
pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution averages Tier 2.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution require prior authorization?
13.6% of Part D formularies require prior authorization for pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution. Step therapy: 0%. Quantity limits: 18.2%.
How much does Medicare spend on pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution?
In 2023, total Medicare Part D spending on pilocarpine hydrochloride 12.5 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.
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
- 0.5 ML Bordetella pertussis filamentous hemagglutinin vaccine, inactivated 0.01 MG/ML / Bordetella pertussis fimbriae 2/3 vaccine, inactivated 0.01 MG/ML / Bordetella pertussis pertactin vaccine, inactivated 0.006 MG/ML / Bordetella pertussis toxoid vaccine, inactivated 0.02 MG/ML / diphtheria toxoid vaccine, inactivated 30 UNT/ML / tetanus toxoid vaccine, inactivated 10 UNT/ML Injection [Daptacel] T2.3
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