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Prolensa is a brand of bromfenac. 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, 297 of 5,492 Medicare Part D and Medicare Advantage drug plans (5.4%) list Prolensa on their formulary, across 7 of 286 formularies. The most common placement is tier 2 (268 plans, 90.2% 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 2,234 of 5,492 plans (40.7%).
11 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $45; 286 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: 449 of 5,496 plans covered it (8.2%); 2027: 297 of 5,492 (5.4%).
Of 4,367 plans offered in both years, 0 added it to the formulary and 73 dropped it.
Among plans covering it both years, 0 moved it to a higher tier and 230 to a lower one; 0 added prior authorization and 0 removed it.
| Tier | Plans |
|---|---|
| Tier 2 | 268 |
| Tier 3 | 29 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 68 of 323 | 21.1% | 0% |
| Medicare Advantage with drugs (MA-PD) | 118 of 3,200 | 3.7% | 0% |
| Special needs plans (SNP) | 111 of 1,969 | 5.6% | 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 | 0 of 631 | No tier listed | 0 |
| Wellcare | 268 of 268 | Tier 2 | 0 |
| HealthSpring | 0 of 226 | No tier listed | 0 |
| Kaiser Permanente | 0 of 112 | No tier listed | 0 |
| SCAN Health Plan | 0 of 83 | No tier listed | 0 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 0 of 80 | No tier listed | 0 |
| Alignment Health Plan | 0 of 77 | No tier listed | 0 |
| Anthem Blue Cross and Blue Shield | 0 of 74 | No tier listed | 0 |
| Wellpoint | 0 of 63 | No tier listed | 0 |
| Priority Health Medicare | 0 of 40 | No tier listed | 0 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 0 of 36 | No tier listed | 0 |
| Capital Blue Cross | 0 of 35 | No tier listed | 0 |
| Prominence Health Plan | 29 of 29 | Tier 3 | 0 |
| Medica | 0 of 27 | No tier listed | 0 |
| Anthem HealthKeepers | 0 of 26 | No tier listed | 0 |
| Blue Cross Blue Shield of Michigan | 0 of 26 | No tier listed | 0 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 2 of 114 | 1.8% |
| Alaska | 2 of 9 | 22.2% |
| American Samoa | 0 of 1 | 0% |
| Arizona | 7 of 147 | 4.8% |
| Arkansas | 6 of 85 | 7.1% |
| California | 16 of 397 | 4% |
| Colorado | 2 of 106 | 1.9% |
| Connecticut | 6 of 54 | 11.1% |
| Delaware | 5 of 43 | 11.6% |
| District of Columbia | 0 of 12 | 0% |
| Florida | 28 of 545 | 5.1% |
| Georgia | 15 of 149 | 10.1% |
| Guam | 0 of 1 | 0% |
| Hawaii | 2 of 50 | 4% |
| Idaho | 2 of 45 | 4.4% |
| Illinois | 9 of 132 | 6.8% |
| Indiana | 5 of 138 | 3.6% |
| Iowa | 6 of 64 | 9.4% |
| Kansas | 5 of 84 | 6% |
| Kentucky | 9 of 121 | 7.4% |
| Louisiana | 12 of 125 | 9.6% |
| Maine | 6 of 52 | 11.5% |
| Maryland | 2 of 49 | 4.1% |
| Massachusetts | 2 of 89 | 2.2% |
| Michigan | 8 of 182 | 4.4% |
| Minnesota | 2 of 63 | 3.2% |
| Mississippi | 15 of 104 | 14.4% |
| Missouri | 7 of 170 | 4.1% |
| Montana | 2 of 27 | 7.4% |
| Nebraska | 5 of 51 | 9.8% |
| Nevada | 14 of 100 | 14% |
| New Hampshire | 2 of 25 | 8% |
| New Jersey | 5 of 73 | 6.8% |
| New Mexico | 2 of 68 | 2.9% |
| New York | 13 of 215 | 6% |
| North Carolina | 8 of 176 | 4.5% |
| North Dakota | 2 of 26 | 7.7% |
| Northern Mariana Islands | 0 of 1 | 0% |
| Ohio | 6 of 171 | 3.5% |
| Oklahoma | 2 of 81 | 2.5% |
| Oregon | 9 of 92 | 9.8% |
| Pennsylvania | 5 of 323 | 1.5% |
| Puerto Rico | 0 of 64 | 0% |
| Rhode Island | 2 of 29 | 6.9% |
| South Carolina | 8 of 89 | 9% |
| South Dakota | 2 of 30 | 6.7% |
| Tennessee | 2 of 156 | 1.3% |
| Texas | 40 of 407 | 9.8% |
| U.S. Virgin Islands | 0 of 1 | 0% |
| Utah | 2 of 53 | 3.8% |
| Vermont | 2 of 14 | 14.3% |
| Virginia | 2 of 144 | 1.4% |
| Washington | 6 of 114 | 5.3% |
| West Virginia | 2 of 69 | 2.9% |
| Wisconsin | 5 of 96 | 5.2% |
| Wyoming | 2 of 13 | 15.4% |
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.
Estimate Prolensa 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.