Medicare Part D coverage · acyclovir · RxCUI 998426
acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese]
Per the CMS 2026 Part D formulary file, acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] is covered by 21 Medicare Part D plans (0.4% of enrollable products), averaging Tier 5, with prior authorization required on 0% of covering formularies.
- 0.4%
- Plan coverage
- 21
- Plans covering
- T5
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese]
Per the CMS 2026 Part D formulary file, acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] (RxNorm concept RXCUI 998426, generic name acyclovir) appears on 3 distinct formulary files spanning 21 Medicare Part D plan offerings - 0.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 670,065 Part D beneficiaries filled acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] 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 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] today.
Coverage Details
- Formularies covering
- 3
- Plans covering
- 21
- Coverage rate
- 0.4%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% 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 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese]
21 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | No | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | No | $0 | NY |
| Univera SeniorChoice Core (PPO) | Excellus Health Plan, Inc. | T5 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | Excellus Health Plan, Inc. | T5 | No | $36.90 | NY |
| Medicare BlueClassic (PPO) | Excellus Health Plan, Inc. | T5 | No | $51.00 | NY |
| Univera SeniorChoice Secure (HMO-POS) | Excellus Health Plan, Inc. | T5 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | Excellus Health Plan, Inc. | T5 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | Excellus Health Plan, Inc. | T5 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | Excellus Health Plan, Inc. | T5 | No | $58.60 | NY |
| Medicare BlueEnhanced (PPO) | Excellus Health Plan, Inc. | T5 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | Excellus Health Plan, Inc. | T5 | No | $86.40 | NY |
| CDPHP Clear Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | No | $100.00 | NY |
| CDPHP Choice Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T5 | No | $135.00 | NY |
Show the next 1 plans
| Medicare Blue Choice Optimum (HMO-POS) | Excellus Health Plan, Inc. | T5 | No | $146.00 | NY |
Frequently Asked Questions
Is acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] covered by Medicare Part D?
Yes, acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] is covered by 21 Medicare Part D plans (0.4% of all Part D formularies).
What tier is acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] on Medicare Part D plans?
acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] require prior authorization?
0% of Part D formularies require prior authorization for acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese]?
In 2023, total Medicare Part D spending on acyclovir 50 MG/ML / hydrocortisone 10 MG/ML Topical Cream [Xerese] 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.
Nationwide similar Part D drugs
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
- 0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector T5
- metronidazole 10 MG/ML Topical Cream [Noritate] T5
- 1 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe T5
- formoterol fumarate 0.01 MG/ML Inhalation Solution [Perforomist] T5
- deferiprone 1000 MG Oral Tablet [Ferriprox] T5
- ruxolitinib 15 MG/ML Topical Cream [Opzelura] T5