hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC]

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hydrocortisone acetate

RxCUI: 828364

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
4.6%
Plan Coverage
231
Plans Covering
T2.4
Avg Tier
0%
Prior Auth Required

What the CMS Formulary Data Shows for hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC]

Per the CMS 2026 Part D formulary file, hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] (RxNorm concept RXCUI 828364, generic name hydrocortisone acetate) appears on 14 distinct formulary files spanning 231 Medicare Part D plan offerings - 4.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.4.

Real-world access to hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] depends on utilization management as much as tier placement: 0% 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 430 Part D beneficiaries filled hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] in 2023, with total plan-and-beneficiary spending of $527,716 and an average per-beneficiary annual cost of $1,227.25. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] today.

Coverage Details

Formularies covering
14
Plans covering
231
Coverage rate
4.6%
Tier range
Tier 1 – Tier 4
Average tier
Tier 2, Generic

Restrictions

Prior authorization required
0% of formularies
Step therapy required
0% of formularies
Quantity limits
0% of formularies

2023 Medicare Spending

Beneficiaries
430
Total spending
$527,716
Avg per beneficiary
$1,227.25

Tier Distribution Across Plans

9 plans
Tier 1, Preferred Generic
91 plans
Tier 2, Generic

Medicare Advantage Plans (MA-PD) Covering hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC]

100 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Abilis Health Community (HMO I-SNP) SIGNATURE ADVANTAGE, LLC T1 No $0 KY, TN
Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) ARKANSAS SUPERIOR SELECT, INC. T1 No $0 AR
Texas Independence Health Plan, Inc. (HMO I-SNP) TEXAS INDEPENDENCE HEALTH PLAN, INC. T1 No $4.80 TX
Texas Independence Community Plan (HMO I-SNP) TEXAS INDEPENDENCE HEALTH PLAN, INC. T1 No $4.80 TX
Tribute Select (HMO-POS I-SNP) ARKANSAS SUPERIOR SELECT, INC. T1 No $8.90 AR
Valor Health Plan (HMO I-SNP) TSG GUARD, INC. T1 No $31.40 OH
WV Senior Advantage (HMO I-SNP) WEST VIRGINIA SENIOR ADVANTAGE, INC. T1 No $32.70 WV
Abilis Health (HMO I-SNP) SIGNATURE ADVANTAGE, LLC T1 No $35.90 KY, TN
CommuniCare Advantage ISNP (HMO I-SNP) OH CHS SNP INC. T1 No $38.40 IN, MD, OH
Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Inland Empire (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Kern (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Stanis (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Fresno (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Santa Cruz (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Alameda (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic SF (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Contra Costa (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Adv Basic Santa Clara (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic Solano (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Basic San Mateo (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage LA, Orange Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Sr Advantage Inland Empire Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage San Diego Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Ventura Value (HMO) KAISER FOUNDATION HP, INC. T2 No $0 CA
Kaiser Permanente Senior Advantage Core DM (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Silver DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core South (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Core North (HMO) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete Pueblo (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Senior Advantage Bronze DM (HMO-POS) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF CO T2 No $0 CO
Kaiser Permanente Dual Essential Plan 1 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 1 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Essential Plan 2 (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic 2 (HMO) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Care Plus (HMO-POS) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Dual Complete (HMO D-SNP) KAISER FOUNDATION HP OF GA, INC. T2 No $0 GA
Kaiser Permanente Senior Advantage Basic (HMO) KAISER FOUNDATION HP, INC. T2 No $0 HI

Frequently Asked Questions

Is hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] covered by Medicare Part D?

Yes, hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] is covered by 231 Medicare Part D plans (4.6% of all Part D formularies).

What tier is hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] on Medicare Part D plans?

hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] averages Tier 2.4 across Part D plans, ranging from Tier 1 to Tier 4.

Does hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] require prior authorization?

0% of Part D formularies require prior authorization for hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC]. Step therapy: 0%. Quantity limits: 0%.

How much does Medicare spend on hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC]?

In 2023, total Medicare Part D spending on hydrocortisone acetate 10 MG/ML / pramoxine hydrochloride 10 MG/ML Rectal Foam [Proctofoam-HC] was $527,716, covering 430 beneficiaries. The average spend per beneficiary was $1,227.25.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial