bromfenac sodium
0.07 %, 0.075 % — Drops
Also known as:
PROLENSA
BROMSITE
Bromfenac Sodium (Once-Daily) Ophthalmic Solution
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Coverage by Insurer
Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.
AmeriHealth Caritas NC
7 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | ✓ | — | ST |
Cigna
20 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Connect Bronze RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 7000 HSA Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 4400 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 5000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 3500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 3500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver 3000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 6500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect myDiabetesCare Silver | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD 2200 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Silver RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold RD CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze CMS Standard | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Gold 1500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect myDiabetesCare Bronze | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze 5500 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
| Connect Bronze RD 6000 Indiv Med Deductible | Tier 3 - Preferred Brand | — | — | — | None |
Medicare Part D
49 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Longevity Health Plan (HMO I-SNP) | Tier 1 - Preferred Generic | — | — | — | None |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Tier 2 - Generic | — | — | — | None |
| Blue Medicare PPO Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Essential Plus (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Enhanced (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Essential (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Experience Health Medicare Advantage (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Healthy Blue + Medicare (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health Platinum (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health NC Duals (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health smartHMO (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health Platinum Select (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Alignment Health AVA (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty Open (PPO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Assist Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Access (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Liberty (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Dual Reserve (HMO-POS D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Blue Medicare Choice (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Simple Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Simple (HMO-POS) | Tier 4 - Non-Preferred | — | — | — | None |
| Wellcare Giveback Open (PPO) | Tier 4 - Non-Preferred | — | — | — | None |