| Drug Name | Covered | Not Covered |
|---|---|---|
| Alphagan P | $10 | - |
| Bromsite | $35 | $60 |
| Cequa | $0 | - |
| Combigan | $10 | - |
| Cosopt PF | $0 | - |
| Durysta | $0 | - |
| Eysuvis | $30 | - |
| Ilevro | $0 | $59 |
| Inveltys | $60 | - |
| Iyuzeh PF | $0 | $75 |
| Lumigan | $30 | - |
| Miebo | $0 60 day free trial |
- |
| Prolensa (DAW) | $25 | $80 |
| Restasis | $0 | - |
| Rhopressa | $0 | $30 |
| Rocklatan | $0 | $30 |
| Simbrinza | $0 | $30 |
| Tobrex | $0 | - |
| Tyrvaya | $10 | - |
| Vevye | $0 | - |
| Vigamox | $0 | $59 |
| Xalatan (DAW) | $0 | - |
| Xiidra | $0 | - |
| Zirgan | $25 | $70 |