Loteprednol-Tobramycin Ophthalmic
0.3 % — Suspension
Also known as:
Loteprednol-Tobramycin Ophthalmic Suspension
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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
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| AmeriHealth Caritas Next Bronze Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Gold Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Premier + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Bronze Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Signature + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals | Tier 2 - Generic | — | — | — | None |
| AmeriHealth Caritas Next Silver Essential + No Referrals | Tier 2 - Generic | — | — | — | None |
Medicare Part D
44 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Aetna Medicare Enhanced (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring True Choice (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring TotalCare Plus (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Select (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Savings (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| HealthSpring Preferred Plus (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED DUAL FULL 013 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 016 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED C-SNP PREMIUM 018 NC (HMO C-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED DUAL PLUS 006 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED DUAL 009 NC (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED GIVEBACK 002 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED GIVEBACK 012 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 001 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 002 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 003 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 004 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 005 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 006 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE 008 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CHOICE GIVEBACK 009 NC (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| DEVOTED CORE 001 NC (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 3 - Preferred Brand | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 3 - Preferred Brand | — | — | — | None |