BRIMONIDINE 1 mg/mL Solution/ Drops
Also known as Brimonidine Tartrate. Coverage in Hawaii (CMS PDP Region 33).
1 of 8 stand-alone Part D plans in Hawaii cover this drug on tier 3.
No plan applies a prior authorization, step therapy or quantity limit.
7 Medicare Advantage plans in HI do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. HI: 7 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible | 3Preferred Brand | 17% | 17% | $21.6030 | — | None |
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.