TRAVOPROST OPHTHALMIC .04 mg/mL Solution
Also known as Travoprost Ophthalmic Solution. Coverage in New Mexico (CMS PDP Region 26).
4 of 11 stand-alone Part D plans in New Mexico cover this drug on tier 3–4.
1 of 4 plans apply a prior authorization, step therapy or quantity limit.
66 Medicare Advantage plans in NM 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. NM: 66 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)$82.30/mo premium · $130.00 deductible | 3Preferred Brand | 16% | 16% | $18.4342 | — | None |
| SilverScript Choice (PDP)$104.00/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $15.0948 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $36.7235 | — | None |
| Blue Cross MedicareRx Value (PDP)$111.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $19.5881 | $117.536 units |
|
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.