dapsone 0.075 MG/MG Topical Gel
dapsone
RxCUI: 1741905
What the CMS Formulary Data Shows for dapsone 0.075 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, dapsone 0.075 MG/MG Topical Gel (RxNorm concept RXCUI 1741905, generic name dapsone) appears on 5 distinct formulary files spanning 39 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 dapsone 0.075 MG/MG Topical Gel depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 20% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 25,257 Part D beneficiaries filled dapsone 0.075 MG/MG Topical Gel in 2023, with total plan-and-beneficiary spending of $9,613,959 and an average per-beneficiary annual cost of $380.65. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dapsone 0.075 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 5
- Plans covering
- 39
- Coverage rate
- 0.8%
- Tier range
- Tier 4, Non-Preferred
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 20% of formularies
2023 Medicare Spending
- Beneficiaries
- 25,257
- Total spending
- $9,613,959
- Avg per beneficiary
- $380.65
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering dapsone 0.075 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 | No | No | $164.80 | - |
| Blue Rx PDP Plus (PDP) | HM HEALTH INSURANCE COMPANY | T4 | No | No | $193.20 | - |
Medicare Advantage Plans (MA-PD) Covering dapsone 0.075 MG/MG Topical Gel
37 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 |
| Network Health Select (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $0 | WI |
| Network Health Go (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $0 | WI |
| Network Health Anywhere (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $0 | WI |
| Network Health Choice (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $0 | WI |
| Network Health Zero (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $0 | WI |
| CDPHP $0 Medicare Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $0 | NY |
| Network Health Cares (PPO D-SNP) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $21.10 | WI |
| 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 |
| Network Health PlusRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $38.60 | WI |
| Medicare BlueClassic (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $51.00 | NY |
| Security Blue HMO-POS Standard (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $51.80 | PA |
| 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 |
| Medicare BlueEnhanced (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $70.30 | NY |
| Medicare BluePlus (PPO) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $86.40 | NY |
| Network Health PremierRx (PPO) | NETWORK HEALTH INSURANCE CORPORATION | T4 | No | $92.80 | WI |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $95.70 | PA |
| Security Blue HMO-POS Deluxe (HMO-POS) | HIGHMARK CHOICE COMPANY | T4 | No | $95.90 | PA |
| Freedom Blue PPO Standard (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $98.20 | PA |
| CDPHP Clear Rx (HMO) | CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC. | T4 | No | $100.00 | NY |
| Freedom Blue PPO Select (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $115.70 | PA |
| Freedom Blue PPO Deluxe (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $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 | No | $140.90 | PA |
| Freedom Blue PPO Classic (PPO) | HIGHMARK SENIOR HEALTH COMPANY | T4 | No | $145.40 | PA |
| Medicare Blue Choice Optimum (HMO-POS) | EXCELLUS HEALTH PLAN, INC. | T4 | No | $146.00 | NY |
Frequently Asked Questions
Is dapsone 0.075 MG/MG Topical Gel covered by Medicare Part D?
Yes, dapsone 0.075 MG/MG Topical Gel is covered by 39 Medicare Part D plans (0.8% of all Part D formularies).
What tier is dapsone 0.075 MG/MG Topical Gel on Medicare Part D plans?
dapsone 0.075 MG/MG Topical Gel averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.
Does dapsone 0.075 MG/MG Topical Gel require prior authorization?
0% of Part D formularies require prior authorization for dapsone 0.075 MG/MG Topical Gel. Step therapy: 0%. Quantity limits: 20%.
How much does Medicare spend on dapsone 0.075 MG/MG Topical Gel?
In 2023, total Medicare Part D spending on dapsone 0.075 MG/MG Topical Gel was $9,613,959, covering 25,257 beneficiaries. The average spend per beneficiary was $380.65.
Read our methodology - how this data is sourced, computed, and verified.