Medicare Part D coverage · adapalene · RxCUI 798061
adapalene 1 MG/ML Medicated Pad
Per the CMS 2026 Part D formulary file, adapalene 1 MG/ML Medicated Pad is covered by 22 Medicare Part D plans (0.4% of enrollable products), averaging Tier 3, with prior authorization required on 100% of covering formularies.
- 0.4%
- Plan coverage
- 22
- Plans covering
- T3
- Avg tier
- 100%
- Prior auth required
What the CMS Formulary Data Shows for adapalene 1 MG/ML Medicated Pad
Per the CMS 2026 Part D formulary file, adapalene 1 MG/ML Medicated Pad (RxNorm concept RXCUI 798061, generic name adapalene) appears on 2 distinct formulary files spanning 22 Medicare Part D plan offerings - 0.4% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 2 to Tier 4, with a cross-plan average of Tier 3.
Real-world access to adapalene 1 MG/ML Medicated Pad depends on utilization management as much as tier placement: 100% 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 4,155 Part D beneficiaries filled adapalene 1 MG/ML Medicated Pad in 2023, with total plan-and-beneficiary spending of $2,842,497 and an average per-beneficiary annual cost of $684.11. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry adapalene 1 MG/ML Medicated Pad today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 22
- Coverage rate
- 0.4%
- Tier range
- Tier 2 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,155
- Total spending
- $2,842,497
- Avg per beneficiary
- $684.11
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering adapalene 1 MG/ML Medicated Pad
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T2 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T2 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering adapalene 1 MG/ML Medicated Pad
20 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T2 | Yes | $51.80 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | Yes | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T2 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T2 | Yes | $98.20 | PA |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T2 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T2 | Yes | $122.40 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T2 | Yes | $145.40 | PA |
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $0 | MI |
| HAP Member Assist (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $8.80 | MI |
| HAP Medicare Complete Assist (PPO D-SNP) | Alliance Health AND Life Insurance Company | T4 | Yes | $8.80 | MI |
| HAP Medicare Diabetes and Heart (HMO C-SNP) | Health Alliance Plan OF Michigan | T4 | Yes | $8.80 | MI |
| HAP Senior Plus Henry Ford Tiered Access (HMO) | Health Alliance Plan OF Michigan | T4 | Yes | $11.30 | MI |
| HAP Senior Plus (HMO-POS) | Health Alliance Plan OF Michigan | T4 | Yes | $13.50 | MI |
| HAP Senior Plus (PPO) | Alliance Health AND Life Insurance Company | T4 | Yes | $42.60 | MI |
Frequently Asked Questions
Is adapalene 1 MG/ML Medicated Pad covered by Medicare Part D?
Yes, adapalene 1 MG/ML Medicated Pad is covered by 22 Medicare Part D plans (0.4% of all Part D formularies).
What tier is adapalene 1 MG/ML Medicated Pad on Medicare Part D plans?
adapalene 1 MG/ML Medicated Pad averages Tier 3 across Part D plans, ranging from Tier 2 to Tier 4.
Does adapalene 1 MG/ML Medicated Pad require prior authorization?
100% of Part D formularies require prior authorization for adapalene 1 MG/ML Medicated Pad. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on adapalene 1 MG/ML Medicated Pad?
In 2023, total Medicare Part D spending on adapalene 1 MG/ML Medicated Pad was $2,842,497, covering 4,155 beneficiaries. The average spend per beneficiary was $684.11.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
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