Medicare Part D coverage · imiquimod · RxCUI 967017
imiquimod 37.5 MG/ML Topical Cream
Per the CMS 2026 Part D formulary file, imiquimod 37.5 MG/ML Topical Cream is covered by 855 Medicare Part D plans (16.9% of enrollable products), averaging Tier 3.3, with prior authorization required on 0% of covering formularies.
- 16.9%
- Plan coverage
- 855
- Plans covering
- T3.3
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for imiquimod 37.5 MG/ML Topical Cream
Per the CMS 2026 Part D formulary file, imiquimod 37.5 MG/ML Topical Cream (RxNorm concept RXCUI 967017, generic name imiquimod) appears on 21 distinct formulary files spanning 855 Medicare Part D plan offerings - 16.9% 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 3.3.
Real-world access to imiquimod 37.5 MG/ML Topical Cream depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 4.8% require step therapy. 61.9% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 124,101 Part D beneficiaries filled imiquimod 37.5 MG/ML Topical Cream in 2023, with total plan-and-beneficiary spending of $8,603,449 and an average per-beneficiary annual cost of $69.33. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry imiquimod 37.5 MG/ML Topical Cream today.
Coverage Details
- Formularies covering
- 21
- Plans covering
- 855
- Coverage rate
- 16.9%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 4.8% of formularies
- Quantity limits
- 61.9% of formularies
2023 Medicare Spending
- Beneficiaries
- 124,101
- Total spending
- $8,603,449
- Avg per beneficiary
- $69.33
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering imiquimod 37.5 MG/ML Topical Cream
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| 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 |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T2 | No | $47.00 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T2 | No | $59.70 | PA |
| Keystone 65 Select Rx (HMO) | Keystone Health Plan East, Inc. | T2 | No | $63.50 | PA |
| Keystone 65 Preferred Rx (HMO) | Keystone Health Plan East, Inc. | T2 | No | $79.70 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T2 | No | $102.20 | PA |
| Personal Choice 65 Rx (PPO) | QCC Insurance Company | T2 | No | $112.70 | PA |
| Freedom VIP Care (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
Show the next 30 plans
| Optimum Emerald Partial (HMO D-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Freedom Máximo (HMO-POS) | Freedom Health, Inc. | T3 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Platinum Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Gold Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Gold Plus Plan (HMO) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | Optimum Healthcare, Inc. | T3 | No | $0 | FL |
| Aetna Medicare Signature (HMO) | Aetna Health OF California Inc. | T4 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | Aetna Health OF California Inc. | T4 | No | $0 | CA |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is imiquimod 37.5 MG/ML Topical Cream covered by Medicare Part D?
Yes, imiquimod 37.5 MG/ML Topical Cream is covered by 855 Medicare Part D plans (16.9% of all Part D formularies).
What tier is imiquimod 37.5 MG/ML Topical Cream on Medicare Part D plans?
imiquimod 37.5 MG/ML Topical Cream averages Tier 3.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does imiquimod 37.5 MG/ML Topical Cream require prior authorization?
0% of Part D formularies require prior authorization for imiquimod 37.5 MG/ML Topical Cream. Step therapy: 4.8%. Quantity limits: 61.9%.
How much does Medicare spend on imiquimod 37.5 MG/ML Topical Cream?
In 2023, total Medicare Part D spending on imiquimod 37.5 MG/ML Topical Cream was $8,603,449, covering 124,101 beneficiaries. The average spend per beneficiary was $69.33.
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.