Medicare Part D coverage · acyclovir · RxCUI 197312
acyclovir 0.05 MG/MG Topical Ointment
Per the CMS 2026 Part D formulary file, acyclovir 0.05 MG/MG Topical Ointment is covered by 2,261 Medicare Part D plans (44.8% of enrollable products), averaging Tier 2.7, with prior authorization required on 25.8% of covering formularies.
- 44.8%
- Plan coverage
- 2,261
- Plans covering
- T2.7
- Avg tier
- 25.8%
- Prior auth required
What the CMS Formulary Data Shows for acyclovir 0.05 MG/MG Topical Ointment
Per the CMS 2026 Part D formulary file, acyclovir 0.05 MG/MG Topical Ointment (RxNorm concept RXCUI 197312, generic name acyclovir) appears on 229 distinct formulary files spanning 2,261 Medicare Part D plan offerings - 44.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.7.
Real-world access to acyclovir 0.05 MG/MG Topical Ointment depends on utilization management as much as tier placement: 25.8% of covering formularies require prior authorization. 0.4% require step therapy. 89.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 670,065 Part D beneficiaries filled acyclovir 0.05 MG/MG Topical Ointment in 2023, with total plan-and-beneficiary spending of $49,435,094 and an average per-beneficiary annual cost of $73.78. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry acyclovir 0.05 MG/MG Topical Ointment today.
Coverage Details
- Formularies covering
- 229
- Plans covering
- 2,261
- Coverage rate
- 44.8%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 25.8% of formularies
- Step therapy required
- 0.4% of formularies
- Quantity limits
- 89.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 670,065
- Total spending
- $49,435,094
- Avg per beneficiary
- $73.78
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering acyclovir 0.05 MG/MG Topical Ointment
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | Yes | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | Yes | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | Yes | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | Yes | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | Yes | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | Yes | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| KeyCare Advantage Plus (HMO C-SNP) | Isnp Ventures, LLC | T1 | No | $0 | MD |
| Premier Care (HMO-POS I-SNP) | Lifeworks Advantage, LLC | T1 | No | $0 | VA |
| Premier Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Advantage Care (HMO) | Align Senior Care California Inc. | T1 | No | $0 | CA |
| Premier Care (HMO-POS I-SNP) | Align Senior Care MI, LLC | T1 | No | $0 | MI |
| Premier Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | No | $0 | FL |
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | CO |
| Perennial Advantage Freedom (HMO) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Premier (HMO I-SNP) | Perennial Advantage OF Colorado, Inc. | T1 | No | $0 | PA |
| Perennial Advantage Freedom (HMO-POS) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
Show the next 30 plans
| Perennial Advantage Premier (HMO-POS I-SNP) | Perennial Advantage OF Ohio, Inc. | T1 | No | $0 | OH |
| ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | No | $0 | TX |
| PruittHealth Premier Advantage (HMO I-SNP) | Pruitthealth Premier, Inc. | T1 | No | $0 | GA |
| Senior Health Plan Silver Plus (HMO) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) | Communitycare Government Programs, Inc. | T1 | No | $0 | OK |
| Community First Medicare Advantage Alamo Plan (HMO) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community First Medicare Advantage D-SNP (HMO D-SNP) | Community First Health Plans, Inc. | T1 | No | $0 | TX |
| Community DualCare Aligned (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| Community DualCare Access (HMO D-SNP) | Community Health Choice Texas, Inc. | T1 | No | $0 | TX |
| El Paso Health Medicare Advantage Dual (HMO D-SNP) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Total (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| El Paso Health Giveback (HMO) | EL Paso First Health Plans, Inc. | T1 | No | $0 | TX |
| Liberty Medicare Advantage (HMO C-SNP) | Liberty Advantage, LLC | T1 | No | $0 | NC |
| Peak Advantage Vista (PPO) | Peak Health Insurance Corporation | T1 | No | $0 | PA, WV |
| SECUR Edge (HMO I-SNP) | Secur Inc | T1 | No | $0 | FL |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | No | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is acyclovir 0.05 MG/MG Topical Ointment covered by Medicare Part D?
Yes, acyclovir 0.05 MG/MG Topical Ointment is covered by 2,261 Medicare Part D plans (44.8% of all Part D formularies).
What tier is acyclovir 0.05 MG/MG Topical Ointment on Medicare Part D plans?
acyclovir 0.05 MG/MG Topical Ointment averages Tier 2.7 across Part D plans, ranging from Tier 1 to Tier 4.
Does acyclovir 0.05 MG/MG Topical Ointment require prior authorization?
25.8% of Part D formularies require prior authorization for acyclovir 0.05 MG/MG Topical Ointment. Step therapy: 0.4%. Quantity limits: 89.5%.
How much does Medicare spend on acyclovir 0.05 MG/MG Topical Ointment?
In 2023, total Medicare Part D spending on acyclovir 0.05 MG/MG Topical Ointment was $49,435,094, covering 670,065 beneficiaries. The average spend per beneficiary was $73.78.
Read our methodology - how this data is sourced, computed, and verified.
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Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
Similar prior-authorization rate
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