Phospholine Iodide
Generic: echothiophate iodide
1.25 MG — Ophthalmic Solution
Ophthalmic Antiglaucoma Agents
Also known as:
echothiophate iodide
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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.
Medicare Part D
18 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Value Plus (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Prime (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Care (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Full Dual Care (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Chronic Care Value (HMO C-SNP) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Enhanced (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Extra (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature Giveback (PPO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Signature (HMO) | Tier 5 - Specialty | — | — | — | None |
| Aetna Medicare Dual (HMO D-SNP) | Tier 5 - Specialty | — | — | — | None |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| Silver Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Diabetes | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Classic Standard | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Secure | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Classic 4700 | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Classic | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Elite + PCP Saver Plus | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple PCP Saver | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Gold Elite Saver Plus | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Bronze Simple Diabetes | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Chronic Care CKM | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| Silver Simple Women's Health with Menopause Benefits | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | Tier 4 - Non-Preferred | — | — | — | None |
| AIAN Cost Share | with Atrium Health | Tier 4 - Non-Preferred | — | — | — | None |
UnitedHealthcare
17 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus+ $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Essential ($0 Virtual Urgent Care, HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Copay Focus $0 Ded ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard (HSA, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Standard ($8 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Value+ ($0 Virtual Urgent Care, $5 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Bronze Standard+ (HSA, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Advantage+ ($0 Virtual Urgent Care, $1 Tier 2 Rx, $0 Insulin, Dental + Vision, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |
| UHC Gold Standard ($5 Tier 2 Rx, $0 Insulin, No Referrals) | Tier 3 - Preferred Brand | — | — | — | None |