Medicare Part D coverage · fluorouracil · RxCUI 284191
fluorouracil 5 MG/ML Topical Cream
Per the CMS 2026 Part D formulary file, fluorouracil 5 MG/ML Topical Cream is covered by 1,153 Medicare Part D plans (22.8% of enrollable products), averaging Tier 3.8, with prior authorization required on 10% of covering formularies.
- 22.8%
- Plan coverage
- 1,153
- Plans covering
- T3.8
- Avg tier
- 10%
- Prior auth required
What the CMS Formulary Data Shows for fluorouracil 5 MG/ML Topical Cream
Per the CMS 2026 Part D formulary file, fluorouracil 5 MG/ML Topical Cream (RxNorm concept RXCUI 284191, generic name fluorouracil) appears on 60 distinct formulary files spanning 1,153 Medicare Part D plan offerings - 22.8% 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 3.8.
Real-world access to fluorouracil 5 MG/ML Topical Cream depends on utilization management as much as tier placement: 10% of covering formularies require prior authorization. 0% require step therapy. 15% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 500,442 Part D beneficiaries filled fluorouracil 5 MG/ML Topical Cream in 2023, with total plan-and-beneficiary spending of $52,836,157 and an average per-beneficiary annual cost of $105.58. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry fluorouracil 5 MG/ML Topical Cream today.
Coverage Details
- Formularies covering
- 60
- Plans covering
- 1,153
- Coverage rate
- 22.8%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 10% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 15% of formularies
2023 Medicare Spending
- Beneficiaries
- 500,442
- Total spending
- $52,836,157
- Avg per beneficiary
- $105.58
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering fluorouracil 5 MG/ML Topical Cream
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| 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 Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| 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 |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| 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 |
Show the next 30 plans
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| 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 |
| Health First Rewards H1099-014 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | Health First Health Plans | T2 | No | $0 | FL |
| Health First Value H1099-006 (HMO) | Health First Health Plans | T2 | No | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | Health First Health Plans | T2 | No | $49.40 | FL |
| Mass General Brigham Advantage (PPO) | Mass General Brigham Health Plan, Inc. | T3 | No | $0 | MA |
| CarePartners Access (PPO) | Carepartners OF Connecticut, Inc. | T3 | No | $0 | CT |
| Tufts Medicare Preferred HMO Basic Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $0 | MA |
| Tufts Medicare Preferred HMO Smart Saver Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $0 | MA |
| CarePartners of CT CareAdvantage Preferred (HMO) | Carepartners OF Connecticut, Inc. | T3 | No | $0 | CT |
| Tufts Medicare Preferred PPO RX (PPO) | Tufts Associated Health Maintenance Organization | T3 | No | $0 | MA |
| Tufts Medicare Preferred HMO Value Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $14.60 | MA |
| Tufts Medicare Preferred HMO Basic Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $21.90 | MA |
| Tufts Medicare Preferred HMO Prime Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $25.90 | MA |
| Tufts Medicare Preferred HMO Prime Rx (HMO) | Tufts Associated Health Maintenance Organization | T3 | No | $40.90 | MA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is fluorouracil 5 MG/ML Topical Cream covered by Medicare Part D?
Yes, fluorouracil 5 MG/ML Topical Cream is covered by 1,153 Medicare Part D plans (22.8% of all Part D formularies).
What tier is fluorouracil 5 MG/ML Topical Cream on Medicare Part D plans?
fluorouracil 5 MG/ML Topical Cream averages Tier 3.8 across Part D plans, ranging from Tier 1 to Tier 5.
Does fluorouracil 5 MG/ML Topical Cream require prior authorization?
10% of Part D formularies require prior authorization for fluorouracil 5 MG/ML Topical Cream. Step therapy: 0%. Quantity limits: 15%.
How much does Medicare spend on fluorouracil 5 MG/ML Topical Cream?
In 2023, total Medicare Part D spending on fluorouracil 5 MG/ML Topical Cream was $52,836,157, covering 500,442 beneficiaries. The average spend per beneficiary was $105.58.
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
- sodium oxybate 4500 MG Granules for Oral Suspension [Lumryz] T3.8
- sofosbuvir 400 MG Oral Tablet [Sovaldi] T3.8
- 24 HR oxcarbazepine 600 MG Extended Release Oral Tablet T3.8
- {2 (0.1 ML) (diazepam 100 MG/ML Nasal Spray [Valtoco]) } Pack [Valtoco 20 MG Dose Kit] T3.8
- alosetron 1 MG Oral Tablet T3.8
- clobazam 5 MG Oral Film [Sympazan] T3.8
Similar prior-authorization rate
- ampicillin 100 MG/ML / sulbactam 50 MG/ML Injectable Solution 10% PA
- tobramycin 10 MG/ML Injectable Solution 10% PA
- calcitriol 0.000003 MG/MG Topical Ointment 10% PA
- sotalol hydrochloride 5 MG/ML Oral Solution [Sotylize] 10% PA
- 100 ML metronidazole 5 MG/ML Injection 10.1% PA
- cefuroxime 750 MG Injection 10.1% PA