FillMapÓptimo Plus (PPO)

Does Óptimo Plus (PPO) cover cyclosporine?

Óptimo Plus (PPO)
H4005-004-0 · MA_LOCAL · Medicare Part D
cyclosporine
Do you get help with your Medicare drug costs?None of these

Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.

cyclosporineunder Óptimo Plus (PPO)
Covered — some forms require prior authorization
13 of 15 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$0per 30-day fill

Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.

This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.

Amount limit applies — this plan covers 60 mL per 30 days. You can still fill it — more than that needs your plan's approval, which your doctor's office requests.
Tier
Tier 2
Approval first
Required
Try another first
No
Amount limit
60 mL per 30 days
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.

Covered forms and strengths (15)

  • 0.4 ML cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]Tier 360 mL per 30 days
  • cyclosporine 0.5 MG/ML Ophthalmic Suspension [Restasis]Tier 360 mL per 30 days
  • cyclosporine 100 MG Oral CapsuleTier 2Approval first
  • cyclosporine 100 MG Oral Capsule [Sandimmune]Tier 4Approval first
  • cyclosporine 25 MG Oral CapsuleTier 2Approval first
  • cyclosporine 25 MG Oral Capsule [Sandimmune]Tier 4Approval first
  • cyclosporine, modified 100 MG Oral CapsuleTier 2Approval first
  • cyclosporine, modified 100 MG Oral Capsule [Gengraf]Tier 2Approval first
  • cyclosporine, modified 100 MG Oral Capsule [Neoral]Tier 4Approval first
  • cyclosporine, modified 100 MG/ML Oral SolutionTier 2Approval first
  • cyclosporine, modified 100 MG/ML Oral Solution [Neoral]Tier 4Approval first
  • cyclosporine, modified 25 MG Oral CapsuleTier 2Approval first
  • cyclosporine, modified 25 MG Oral Capsule [Gengraf]Tier 2Approval first
  • cyclosporine, modified 25 MG Oral Capsule [Neoral]Tier 4Approval first
  • cyclosporine, modified 50 MG Oral CapsuleTier 2Approval first

← All coverage for cyclosporine