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Prolensa is a brand of bromfenac. What agents check before quoting it: how many 2026 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2026, 449 of 5,496 Medicare Part D and Medicare Advantage drug plans (8.2%) list Prolensa on their formulary, across 14 of 328 formularies. The most common placement is tier 3 (432 plans, 96.2% of those covering it). 0 of the covering plans require prior authorization (0%), 0 step therapy and 0 a quantity limit. Generic bromfenac is on 2,508 of 5,496 plans (45.6%).
66 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $40; 383 charge coinsurance instead — median 25% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,100 in 2026, covered drugs cost $0 for the rest of the year.
2025: 1,288 of 5,631 plans covered it (22.9%); 2026: 449 of 5,496 (8.2%).
Of 4,368 plans offered in both years, 0 added it to the formulary and 622 dropped it.
Among plans covering it both years, 68 moved it to a higher tier and 0 to a lower one; 0 added prior authorization and 0 removed it.
Medicare Part D paid for 158,877 30-day fills of Prolensa in 2024 for about 68,875 enrollees, at an average total cost of $279.42 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Prolensa and the rest of a client's list on every plan in their county.
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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 09/16/2026). CMS formulary data.