Medicare Part D coverage · diclofenac sodium · RxCUI 1487074
diclofenac sodium 20 MG/ML Topical Solution
Per the CMS 2026 Part D formulary file, diclofenac sodium 20 MG/ML Topical Solution is covered by 497 Medicare Part D plans (9.8% of enrollable products), averaging Tier 3.9, with prior authorization required on 72% of covering formularies.
- 9.8%
- Plan coverage
- 497
- Plans covering
- T3.9
- Avg tier
- 72%
- Prior auth required
What the CMS Formulary Data Shows for diclofenac sodium 20 MG/ML Topical Solution
Per the CMS 2026 Part D formulary file, diclofenac sodium 20 MG/ML Topical Solution (RxNorm concept RXCUI 1487074, generic name diclofenac sodium) appears on 82 distinct formulary files spanning 497 Medicare Part D plan offerings - 9.8% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.9.
Real-world access to diclofenac sodium 20 MG/ML Topical Solution depends on utilization management as much as tier placement: 72% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 3,196,668 Part D beneficiaries filled diclofenac sodium 20 MG/ML Topical Solution in 2023, with total plan-and-beneficiary spending of $395,688,978 and an average per-beneficiary annual cost of $123.78. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry diclofenac sodium 20 MG/ML Topical Solution today.
Coverage Details
- Formularies covering
- 82
- Plans covering
- 497
- Coverage rate
- 9.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 72% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 3,196,668
- Total spending
- $395,688,978
- Avg per beneficiary
- $123.78
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering diclofenac sodium 20 MG/ML Topical Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | Yes | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | Yes | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | Yes | $0 | MN |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $0 | MD |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $0 | AR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | Yes | $0 | CA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | Yes | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Texas Independence Community Plan (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | Yes | $4.80 | TX |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
Show the next 30 plans
| Tribute Select (HMO-POS I-SNP) | Arkansas Superior Select, Inc. | T1 | Yes | $8.90 | AR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| ATRIO Special Needs Plan (HMO D-SNP) | Atrio Health Plans | T1 | Yes | $10.50 | OR |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | Yes | $17.00 | AZ |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
| Alterwood Advantage Dual Value (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | Yes | $31.20 | MD |
| Valor Health Plan (HMO I-SNP) | TSG Guard, Inc. | T1 | Yes | $31.40 | OH |
| WV Senior Advantage (HMO I-SNP) | West Virginia Senior Advantage, Inc. | T1 | Yes | $32.70 | WV |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | No | $35.20 | CO |
| Abilis Health (HMO I-SNP) | Signature Advantage, LLC | T1 | Yes | $35.90 | KY, TN |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | No | $36.20 | NC |
| CommuniCare Advantage ISNP (HMO I-SNP) | OH CHS SNP Inc. | T1 | Yes | $38.40 | IN, MD, OH |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $40.00 | NJ |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | No | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | No | $58.80 | NY |
| Nascentia Skilled Nursing Facility (HMO I-SNP) | Visiting Nurse Association OF Central NEW York | T1 | Yes | $58.80 | NY |
| HealthSpring Preferred (HMO) | Bravo Health Pennsylvania, Inc. | T4 | Yes | $0 | AZ |
| HealthSpring Alliance (HMO) | Bravo Health Pennsylvania, Inc. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred Savings (HMO) | Bravo Health Pennsylvania, Inc. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred Full Savings (HMO) | Bravo Health Pennsylvania, Inc. | T4 | Yes | $0 | AZ |
| HealthSpring Preferred GA (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
| HealthSpring Preferred Savings (HMO) | Healthspring Life & Health Insurance Company, Inc. | T4 | Yes | $0 | GA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is diclofenac sodium 20 MG/ML Topical Solution covered by Medicare Part D?
Yes, diclofenac sodium 20 MG/ML Topical Solution is covered by 497 Medicare Part D plans (9.8% of all Part D formularies).
What tier is diclofenac sodium 20 MG/ML Topical Solution on Medicare Part D plans?
diclofenac sodium 20 MG/ML Topical Solution averages Tier 3.9 across Part D plans, ranging from Tier 1 to Tier 5.
Does diclofenac sodium 20 MG/ML Topical Solution require prior authorization?
72% of Part D formularies require prior authorization for diclofenac sodium 20 MG/ML Topical Solution. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on diclofenac sodium 20 MG/ML Topical Solution?
In 2023, total Medicare Part D spending on diclofenac sodium 20 MG/ML Topical Solution was $395,688,978, covering 3,196,668 beneficiaries. The average spend per beneficiary was $123.78.
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
- daptomycin 500 MG Injection T3.9
- emtricitabine 133 MG / tenofovir disoproxil fumarate 200 MG Oral Tablet T3.9
- 0.6 ML fondaparinux sodium 12.5 MG/ML Prefilled Syringe T3.9
- estradiol 1 MG / norethindrone acetate 0.5 MG / relugolix 40 MG Oral Tablet [Myfembree] T3.9
- rufinamide 40 MG/ML Oral Suspension T3.9
- pirfenidone 267 MG Oral Tablet T3.9
Similar prior-authorization rate
- {7 (siponimod 0.25 MG Oral Tablet [Mayzent]) } Pack [Mayzent 1 MG Starter Pack] 72.1% PA
- 0.5 ML interferon beta-1a 0.044 MG/ML Auto-Injector [Rebif] 71.7% PA
- 0.5 ML interferon beta-1a 0.088 MG/ML Prefilled Syringe [Rebif] 71.7% PA
- 0.5 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen] 71.4% PA
- 0.8 ML filgrastim 0.6 MG/ML Prefilled Syringe [Neupogen] 71.4% PA
- 1 ML filgrastim 0.3 MG/ML Injection [Neupogen] 71.4% PA