adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
adapalene
RxCUI: 829539
What the CMS Formulary Data Shows for adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel (RxNorm concept RXCUI 829539, generic name adapalene) appears on 46 distinct formulary files spanning 320 Medicare Part D plan offerings - 6.3% 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 2.4.
Real-world access to adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel depends on utilization management as much as tier placement: 8.7% of covering formularies require prior authorization. 4.3% require step therapy. 2.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 4,155 Part D beneficiaries filled adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel in 2023, with total plan-and-beneficiary spending of $2,863,677 and an average per-beneficiary annual cost of $689.21. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 46
- Plans covering
- 320
- Coverage rate
- 6.3%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 8.7% of formularies
- Step therapy required
- 4.3% of formularies
- Quantity limits
- 2.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 4,155
- Total spending
- $2,863,677
- Avg per beneficiary
- $689.21
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| 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 |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $0 | IN |
| Provider Partners Maryland Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $0 | MD |
| Provider Partners Missouri Community Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $0 | MO |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | Yes | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | MASS GENERAL BRIGHAM HEALTH PLAN, INC | T1 | No | $0 | MA |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC. | T1 | No | $4.80 | TX |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS | T1 | No | $15.20 | IL |
| Provider Partners Maryland Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Maryland Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN, INC. | T1 | No | $31.20 | MD |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC | T1 | No | $32.70 | PA |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF NORTH CAROLINA | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF INDIANA | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF KENTUCKY | T1 | No | $38.40 | KY |
| Provider Partners Missouri Advantage Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Provider Partners Missouri Essential Plan (HMO I-SNP) | PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC. | T1 | No | $43.00 | MO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T2 | No | $0 | NV |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T2 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | TROY HEALTH, INC. | T2 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | CONTRA COSTA COUNTY MEDICAL SERVICE DBA CONTRA COSTA HEALTH | T2 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T2 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | VISTA HEALTH PLAN, INC. | T2 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | SELECT HEALTH OF SOUTH CAROLINA, INC. | T2 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T2 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T2 | No | $0 | DE |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AMERIHEALTH CARITAS FLORIDA INC | T2 | No | $0 | FL |
Frequently Asked Questions
Is adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel covered by Medicare Part D?
Yes, adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel is covered by 320 Medicare Part D plans (6.3% of all Part D formularies).
What tier is adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel on Medicare Part D plans?
adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel averages Tier 2.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel require prior authorization?
8.7% of Part D formularies require prior authorization for adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel. Step therapy: 4.3%. Quantity limits: 2.2%.
How much does Medicare spend on adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel?
In 2023, total Medicare Part D spending on adapalene 0.001 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel was $2,863,677, covering 4,155 beneficiaries. The average spend per beneficiary was $689.21.
Read our methodology - how this data is sourced, computed, and verified.