Medicare Part D coverage · adapalene · RxCUI 1663745
adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel is covered by 42 Medicare Part D plans (0.8% of enrollable products), averaging Tier 4, with prior authorization required on 40% of covering formularies.
- 0.8%
- Plan coverage
- 42
- Plans covering
- T4
- Avg tier
- 40%
- Prior auth required
What the CMS Formulary Data Shows for adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel (RxNorm concept RXCUI 1663745, generic name adapalene) appears on 5 distinct formulary files spanning 42 Medicare Part D plan offerings - 0.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.
Real-world access to adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel depends on utilization management as much as tier placement: 40% 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 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel 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 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 42
- Coverage rate
- 0.8%
- Tier range
- Tier 4, Non-Preferred
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 40% 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 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Blue Rx PDP Complete (PDP) | HM Health Insurance Company | T4 | Yes | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM Health Insurance Company | T4 | Yes | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel
40 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T4 | No | $0 | NY |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T4 | No | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T4 | No | $0 | NY |
| CDPHP $0 Medicare Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $0 | NY |
| PacificSource Medicare Essentials Rx 27 (HMO) | Pacificsource Community Health Plans | T4 | Yes | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 29 (HMO-POS) | Pacificsource Community Health Plans | T4 | Yes | $0 | MT |
| PacificSource Medicare Essentials Choice Rx 36 (HMO-POS) | Pacificsource Community Health Plans | T4 | Yes | $0 | OR |
| PacificSource Medicare MyCare Rx 40 (HMO) | Pacificsource Community Health Plans | T4 | Yes | $0 | OR |
| PacificSource Dual Care (HMO D-SNP) | Pacificsource Community Health Plans | T4 | Yes | $0 | OR |
| PacificSource Medicare MyCare Choice Rx 34 (HMO-POS) | Pacificsource Community Health Plans | T4 | Yes | $19.00 | ID |
| PacificSource Medicare Essentials Choice Rx 14 (HMO-POS) | Pacificsource Community Health Plans | T4 | Yes | $29.10 | OR |
| Univera SeniorChoice Core (PPO) | Excellus Health Plan, Inc. | T4 | No | $33.00 | NY |
| Univera SeniorChoice Advanced (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $36.90 | NY |
| Medicare BlueClassic (PPO) | Excellus Health Plan, Inc. | T4 | No | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | Highmark Choice Company | T4 | Yes | $51.80 | PA |
Show the next 20 plans
| PacificSource Medicare MyCare Choice Rx 24 (HMO-POS) | Pacificsource Community Health Plans | T4 | Yes | $52.00 | ID |
| Univera SeniorChoice Secure (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $54.90 | NY |
| Medicare BlueBalanced (PPO) | Excellus Health Plan, Inc. | T4 | No | $55.00 | NY |
| Medicare Blue Choice Prime (HMO) | Excellus Health Plan, Inc. | T4 | No | $55.00 | NY |
| Univera SeniorChoice Value Plus (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $58.60 | NY |
| PacificSource Medicare Essentials Rx 41 (HMO) | Pacificsource Community Health Plans | T4 | Yes | $69.30 | OR |
| Medicare BlueEnhanced (PPO) | Excellus Health Plan, Inc. | T4 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | Excellus Health Plan, Inc. | T4 | No | $86.40 | NY |
| PacificSource Medicare Explorer Rx 4 (PPO) | Pacificsource Community Health Plans | T4 | Yes | $88.70 | OR |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | Yes | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | Highmark Choice Company | T4 | Yes | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | Highmark Senior Health Company | T4 | Yes | $98.20 | PA |
| CDPHP Clear Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $100.00 | NY |
| PacificSource Medicare Essentials Rx 6 (HMO) | Pacificsource Community Health Plans | T4 | Yes | $105.90 | OR |
| Freedom Blue PPO Select (PPO) | Highmark Senior Health Company | T4 | Yes | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | Highmark Senior Health Company | T4 | Yes | $122.40 | PA |
| CDPHP Choice Rx (HMO) | Capital District Physicians' Health Plan, Inc. | T4 | No | $135.00 | NY |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T4 | Yes | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | Highmark Senior Health Company | T4 | Yes | $145.40 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | Excellus Health Plan, Inc. | T4 | No | $146.00 | NY |
Frequently Asked Questions
Is adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel covered by Medicare Part D?
Yes, adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel is covered by 42 Medicare Part D plans (0.8% of all Part D formularies).
What tier is adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel on Medicare Part D plans?
adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel require prior authorization?
40% of Part D formularies require prior authorization for adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel?
In 2023, total Medicare Part D spending on adapalene 0.003 MG/MG / benzoyl peroxide 0.025 MG/MG Topical Gel 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
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.
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