polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution
polymyxin B
RxCUI: 244967
What the CMS Formulary Data Shows for polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution
Per the CMS 2026 Part D formulary file, polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution (RxNorm concept RXCUI 244967, generic name polymyxin B) 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 1.4.
Real-world access to polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 9.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 334,644 Part D beneficiaries filled polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution in 2023, with total plan-and-beneficiary spending of $3,745,764 and an average per-beneficiary annual cost of $11.19. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry polymyxin B 10000 UNT/ML / trimethoprim 1 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 1, Preferred Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 9.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 334,644
- Total spending
- $3,745,764
- Avg per beneficiary
- $11.19
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Anthem Full Dual Advantage (PPO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Dual Advantage (PPO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Kidney Care (HMO-POS C-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Full Dual Advantage Select (HMO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Dual Advantage (HMO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution
95 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Blue Medicare HMO Signature (HMO) | Highmark Western and Northeastern New York Inc. | T1 | No | $0 | NY |
| Community Blue Medicare HMO Merit (HMO) | Highmark Western and Northeastern New York Inc. | T1 | No | $0 | NY |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare Plus PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue Plus PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare PPO Signature (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Security Blue HMO-POS ValueRx (HMO-POS) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Together Blue Medicare HMO Signature (HMO) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Community Blue Medicare HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Complete Blue HMO Distinct (HMO) | HIGHMARK CHOICE COMPANY | T1 | No | $0 | PA |
| Complete Blue PPO Distinct (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T1 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T1 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T1 | No | $0 | WV |
| Complete Blue PPO Merit (PPO) | HIGHMARK SENIOR SOLUTIONS COMPANY | T1 | No | $0 | WV |
| Complete Blue PPO Signature (PPO) | HIGHMARK BCBSD INC. | T1 | No | $0 | DE |
| 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 |
| Anthem Medicare Advantage (HMO-POS) | BLUE CROSS OF CALIFORNIA | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | BLUE CROSS OF CALIFORNIA | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | BLUE CROSS OF CALIFORNIA | T1 | No | $0 | CA |
| Anthem Medicare Advantage (HMO-POS) | BLUE CROSS OF CALIFORNIA | T1 | No | $0 | CA |
| Anthem Full Dual Advantage (HMO D-SNP) | ANTHEM INSURANCE COMPANIES, INC. | T1 | No | $0 | IN |
| Anthem I PathWays Dual Care Advantage (HMO D-SNP) | ANTHEM INSURANCE COMPANIES, INC. | T1 | No | $0 | IN |
| Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) | ANTHEM INSURANCE COMPANIES, INC. | T1 | No | $0 | IN |
| Wellpoint Full Dual Advantage (HMO-POS D-SNP) | WELLPOINT IOWA, INC. | T1 | No | $0 | IA |
| Wellpoint Full Dual Advantage 2 (HMO-POS D-SNP) | WELLPOINT IOWA, INC. | T1 | No | $0 | IA |
| Wellpoint Full Dual Advantage (HMO D-SNP) | WELLPOINT WEST VIRGINIA , INC. | T1 | No | $0 | WV |
| Wellpoint Full Dual Advantage (HMO D-SNP) | WELLPOINT WASHINGTON, INC. | T1 | No | $0 | WA |
| Wellpoint Dual Advantage (HMO D-SNP) | WELLPOINT WASHINGTON, INC. | T1 | No | $0 | WA |
| Healthy Blue Dual Advantage (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC. | T1 | No | $0 | LA |
| Healthy Blue Dual Advantage 2 (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC. | T1 | No | $0 | LA |
| Anthem Dual Advantage (PPO D-SNP) | ANTHEM INSURANCE COMPANIES, INC. | T1 | No | $0 | VA |
| Wellpoint Medicare Advantage 2 (HMO-POS) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Kidney Care (HMO-POS C-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Dual Advantage 2 (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Kidney Care (HMO-POS C-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Full Dual Advantage Aligned (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
| Wellpoint Full Dual Advantage 2 (HMO D-SNP) | WELLPOINT TEXAS, INC. | T1 | No | $0 | TX |
Frequently Asked Questions
Is polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution covered by Medicare Part D?
Yes, polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution is covered by 5,067 Medicare Part D plans (100% of all Part D formularies).
What tier is polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution on Medicare Part D plans?
polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution averages Tier 1.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution require prior authorization?
0% of Part D formularies require prior authorization for polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution. Step therapy: 0%. Quantity limits: 9.7%.
How much does Medicare spend on polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution?
In 2023, total Medicare Part D spending on polymyxin B 10000 UNT/ML / trimethoprim 1 MG/ML Ophthalmic Solution was $3,745,764, covering 334,644 beneficiaries. The average spend per beneficiary was $11.19.
Read our methodology - how this data is sourced, computed, and verified.