pilocarpine hydrochloride 12.5 MG/ML Ophthalmic Solution
pilocarpine hydrochloride
RxCUI: 2584552
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 |
| 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) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | NM |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | OH |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred Savings (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | OH |
| HealthSpring Preferred Savings (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | KY, OH |
| HealthSpring Preferred (HMO) | CIGNA HEALTHCARE OF COLORADO, INC. | T3 | No | $0 | CO |
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.