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Bromfenac is the generic ingredient; brand versions: Prolensa. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 2,234 of 5,492 Medicare Part D and Medicare Advantage drug plans (40.7%) list Bromfenac on their formulary, across 145 of 286 formularies. The most common placement is tier 3 (846 plans, 37.9% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 119 a quantity limit.
491 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $8, 144 of them $0; 1,743 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 2,508 of 5,496 plans covered it (45.6%); 2027: 2,234 of 5,492 (40.7%).
Of 4,367 plans offered in both years, 37 added it to the formulary and 62 dropped it.
Among plans covering it both years, 25 moved it to a higher tier and 242 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 60 |
| Tier 2 | 582 |
| Tier 3 | 846 |
| Tier 4 | 746 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 97 of 323 | 30% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,372 of 3,200 | 42.9% | 0% |
| Special needs plans (SNP) | 765 of 1,969 | 38.9% | 0% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 0 of 830 | No tier listed | 0 |
| Devoted Health | 0 of 728 | No tier listed | 0 |
| Aetna Medicare | 631 of 631 | Tier 3 | 0 |
| Wellcare | 268 of 268 | Tier 2 | 0 |
| HealthSpring | 191 of 226 | Tier 4 | 0 |
| Kaiser Permanente | 112 of 112 | Tier 2 | 0 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 12 of 80 | Tier 2 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 4 | 0 |
| Wellpoint | 58 of 63 | Tier 4 | 0 |
| Priority Health Medicare | 40 of 40 | Tier 4 | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 0 of 36 | No tier listed | 0 |
| Capital Blue Cross | 8 of 35 | Tier 4 | 0 |
| Prominence Health Plan | 29 of 29 | Tier 2 | 0 |
| Medica | 1 of 27 | Tier 3 | 0 |
| Anthem HealthKeepers | 22 of 26 | Tier 4 | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 32 of 114 | 28.1% |
| Alaska | 3 of 9 | 33.3% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 66 of 147 | 44.9% |
| Arkansas | 34 of 85 | 40% |
| California | 283 of 397 | 71.3% |
| Colorado | 38 of 106 | 35.8% |
| Connecticut | 23 of 54 | 42.6% |
| Delaware | 16 of 43 | 37.2% |
| District of Columbia | 5 of 12 | 41.7% |
| Florida | 183 of 545 | 33.6% |
| Georgia | 72 of 149 | 48.3% |
| Guam | 0 of 1 | 0% |
| Hawaii | 9 of 50 | 18% |
| Idaho | 10 of 45 | 22.2% |
| Illinois | 49 of 132 | 37.1% |
| Indiana | 50 of 138 | 36.2% |
| Iowa | 25 of 64 | 39.1% |
| Kansas | 34 of 84 | 40.5% |
| Kentucky | 43 of 121 | 35.5% |
| Louisiana | 39 of 125 | 31.2% |
| Maine | 16 of 52 | 30.8% |
| Maryland | 16 of 49 | 32.7% |
| Massachusetts | 27 of 89 | 30.3% |
| Michigan | 80 of 182 | 44% |
| Minnesota | 26 of 63 | 41.3% |
| Mississippi | 43 of 104 | 41.3% |
| Missouri | 71 of 170 | 41.8% |
| Montana | 4 of 27 | 14.8% |
| Nebraska | 16 of 51 | 31.4% |
| Nevada | 60 of 100 | 60% |
| New Hampshire | 2 of 25 | 8% |
| New Jersey | 35 of 73 | 47.9% |
| New Mexico | 8 of 68 | 11.8% |
| New York | 96 of 215 | 44.7% |
| North Carolina | 73 of 176 | 41.5% |
| North Dakota | 9 of 26 | 34.6% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 62 of 171 | 36.3% |
| Oklahoma | 13 of 81 | 16% |
| Oregon | 37 of 92 | 40.2% |
| Pennsylvania | 131 of 323 | 40.6% |
| Puerto Rico | 21 of 64 | 32.8% |
| Rhode Island | 5 of 29 | 17.2% |
| South Carolina | 41 of 89 | 46.1% |
| South Dakota | 13 of 30 | 43.3% |
| Tennessee | 56 of 156 | 35.9% |
| Texas | 190 of 407 | 46.7% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 13 of 53 | 24.5% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 37 of 144 | 25.7% |
| Washington | 38 of 114 | 33.3% |
| West Virginia | 24 of 69 | 34.8% |
| Wisconsin | 40 of 96 | 41.7% |
| Wyoming | 2 of 13 | 15.4% |
Medicare Part D paid for 164,299 30-day fills of Bromfenac in 2024 for about 71,142 enrollees, at an average total cost of $141.26 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Bromfenac and the rest of a client's list on every plan in their county.
Estimate Bromfenac costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.