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Difluprednate is a generic drug. 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, 2,995 of 5,492 Medicare Part D and Medicare Advantage drug plans (54.5%) list Difluprednate on their formulary, across 183 of 286 formularies. The most common placement is tier 4 (2,091 plans, 69.8% of those covering it). 0 of the covering plans require prior authorization (0%), 41 step therapy and 17 a quantity limit.
522 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $40, 139 of them $0; 2,473 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: 2,970 of 5,496 plans covered it (54%); 2027: 2,995 of 5,492 (54.5%).
Of 4,367 plans offered in both years, 227 added it to the formulary and 69 dropped it.
Among plans covering it both years, 257 moved it to a higher tier and 237 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 104 |
| Tier 2 | 207 |
| Tier 3 | 593 |
| Tier 4 | 2,091 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 134 of 323 | 41.5% | 0% |
| Medicare Advantage with drugs (MA-PD) | 1,710 of 3,200 | 53.4% | 0% |
| Special needs plans (SNP) | 1,151 of 1,969 | 58.5% | 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 | 446 of 728 | Tier 4 | 0 |
| Aetna Medicare | 631 of 631 | Tier 4 | 0 |
| Wellcare | 268 of 268 | Tier 3 | 0 |
| HealthSpring | 226 of 226 | Tier 4 | 0 |
| Kaiser Permanente | 112 of 112 | Tier 4 | 0 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 4 | 0 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 0 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 4 | 0 |
| Wellpoint | 63 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 | 6 of 36 | Tier 4 | 0 |
| Capital Blue Cross | 35 of 35 | Tier 4 | 0 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 26 of 26 | Tier 4 | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 71 of 114 | 62.3% |
| Alaska | 4 of 9 | 44.4% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 84 of 147 | 57.1% |
| Arkansas | 39 of 85 | 45.9% |
| California | 314 of 397 | 79.1% |
| Colorado | 52 of 106 | 49.1% |
| Connecticut | 30 of 54 | 55.6% |
| Delaware | 22 of 43 | 51.2% |
| District of Columbia | 5 of 12 | 41.7% |
| Florida | 292 of 545 | 53.6% |
| Georgia | 82 of 149 | 55% |
| Guam | 0 of 1 | 0% |
| Hawaii | 21 of 50 | 42% |
| Idaho | 6 of 45 | 13.3% |
| Illinois | 54 of 132 | 40.9% |
| Indiana | 60 of 138 | 43.5% |
| Iowa | 30 of 64 | 46.9% |
| Kansas | 43 of 84 | 51.2% |
| Kentucky | 50 of 121 | 41.3% |
| Louisiana | 44 of 125 | 35.2% |
| Maine | 23 of 52 | 44.2% |
| Maryland | 28 of 49 | 57.1% |
| Massachusetts | 62 of 89 | 69.7% |
| Michigan | 94 of 182 | 51.6% |
| Minnesota | 14 of 63 | 22.2% |
| Mississippi | 51 of 104 | 49% |
| Missouri | 82 of 170 | 48.2% |
| Montana | 3 of 27 | 11.1% |
| Nebraska | 21 of 51 | 41.2% |
| Nevada | 58 of 100 | 58% |
| New Hampshire | 6 of 25 | 24% |
| New Jersey | 37 of 73 | 50.7% |
| New Mexico | 15 of 68 | 22.1% |
| New York | 142 of 215 | 66% |
| North Carolina | 80 of 176 | 45.5% |
| North Dakota | 6 of 26 | 23.1% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 85 of 171 | 49.7% |
| Oklahoma | 26 of 81 | 32.1% |
| Oregon | 52 of 92 | 56.5% |
| Pennsylvania | 252 of 323 | 78% |
| Puerto Rico | 63 of 64 | 98.4% |
| Rhode Island | 8 of 29 | 27.6% |
| South Carolina | 43 of 89 | 48.3% |
| South Dakota | 10 of 30 | 33.3% |
| Tennessee | 74 of 156 | 47.4% |
| Texas | 244 of 407 | 60% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 17 of 53 | 32.1% |
| Vermont | 3 of 14 | 21.4% |
| Virginia | 51 of 144 | 35.4% |
| Washington | 59 of 114 | 51.8% |
| West Virginia | 37 of 69 | 53.6% |
| Wisconsin | 30 of 96 | 31.3% |
| Wyoming | 3 of 13 | 23.1% |
Medicare Part D paid for 158,315 30-day fills of Difluprednate in 2024 for about 60,631 enrollees, at an average total cost of $88.34 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Difluprednate and the rest of a client's list on every plan in their county.
Estimate Difluprednate 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.