fluorouracil 5 MG/ML Topical Cream
fluorouracil
RxCUI: 284191
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 61 distinct formulary files spanning 1,166 Medicare Part D plan offerings - 23% 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: 9.8% of covering formularies require prior authorization. 0% require step therapy. 14.8% 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
- 61
- Plans covering
- 1,166
- Coverage rate
- 23%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 9.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 14.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 500,442
- Total spending
- $52,836,157
- Avg per beneficiary
- $105.58
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering fluorouracil 5 MG/ML Topical Cream
2 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| CarePartners Access (PPO) | CAREPARTNERS OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
| CarePartners of CT CareAdvantage Preferred (HMO) | CAREPARTNERS OF CONNECTICUT, INC. | T3 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering fluorouracil 5 MG/ML Topical Cream
98 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 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 |
| 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 |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | GOLD KIDNEY OF ARIZONA | T1 | No | $17.00 | AZ |
| 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 |
| 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 |
| 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 |
| 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 |
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 1,166 Medicare Part D plans (23% 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?
9.8% of Part D formularies require prior authorization for fluorouracil 5 MG/ML Topical Cream. Step therapy: 0%. Quantity limits: 14.8%.
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.