imiquimod 25 MG/ML Topical Cream [Zyclara]
imiquimod
RxCUI: 1248442
What the CMS Formulary Data Shows for imiquimod 25 MG/ML Topical Cream [Zyclara]
Per the CMS 2026 Part D formulary file, imiquimod 25 MG/ML Topical Cream [Zyclara] (RxNorm concept RXCUI 1248442, generic name imiquimod) appears on 7 distinct formulary files spanning 640 Medicare Part D plan offerings - 12.6% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 5 to Tier 5, with a cross-plan average of Tier 5.
Real-world access to imiquimod 25 MG/ML Topical Cream [Zyclara] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 85.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 124,101 Part D beneficiaries filled imiquimod 25 MG/ML Topical Cream [Zyclara] 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 25 MG/ML Topical Cream [Zyclara] today.
Coverage Details
- Formularies covering
- 7
- Plans covering
- 640
- Coverage rate
- 12.6%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 85.7% 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 25 MG/ML Topical Cream [Zyclara]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Prime (HMO-POS) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Extra (HMO) | AETNA HEALTH OF CALIFORNIA INC. | T5 | No | $0 | CA |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature Extra (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare HIDE (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare Dual Care (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature Care (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature (HMO-POS) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | KY |
| Aetna Medicare Partial Dual (HMO D-SNP) | AETNA HEALTH OF OHIO INC. | T5 | No | $0 | OH |
| Aetna Medicare Signature (HMO) | AETNA HEALTH INC.(GA) | T5 | No | $0 | GA |
| Aetna Medicare Signature (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T5 | No | $0 | WI |
| Aetna Medicare Signature (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T5 | No | $0 | IL |
| Aetna Medicare Prime Chronic Care (HMO C-SNP) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T5 | No | $0 | IL |
| Aetna Medicare Signature Extra (HMO-POS) | COVENTRY HEALTH CARE OF ILLINOIS, INC. | T5 | No | $0 | IL |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | IA |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | NE |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS, MO |
| Aetna Medicare Signature Extra (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS, MO |
| Aetna Medicare Signature Plus (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | AR |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS |
| Aetna Medicare Advantra (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | OH |
| Aetna Medicare Advantra Signature Giveback (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | WV |
| Aetna Medicare Elite (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | IA |
| Aetna Medicare Signature Extra (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | NE |
| Aetna Medicare Advantra Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | WV |
| Aetna Medicare Elite (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | IL, MO |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | MO |
| Aetna Medicare Elite (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS, MO |
| Aetna Medicare Elite (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | AR |
| Aetna Medicare Dual (PPO D-SNP) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | SD |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | MO |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS |
| Aetna Medicare Signature (PPO) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | KS |
| Aetna Medicare Dual Extra (PPO D-SNP) | COVENTRY HEALTH AND LIFE INSURANCE COMPANY | T5 | No | $0 | AR |
Frequently Asked Questions
Is imiquimod 25 MG/ML Topical Cream [Zyclara] covered by Medicare Part D?
Yes, imiquimod 25 MG/ML Topical Cream [Zyclara] is covered by 640 Medicare Part D plans (12.6% of all Part D formularies).
What tier is imiquimod 25 MG/ML Topical Cream [Zyclara] on Medicare Part D plans?
imiquimod 25 MG/ML Topical Cream [Zyclara] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does imiquimod 25 MG/ML Topical Cream [Zyclara] require prior authorization?
0% of Part D formularies require prior authorization for imiquimod 25 MG/ML Topical Cream [Zyclara]. Step therapy: 0%. Quantity limits: 85.7%.
How much does Medicare spend on imiquimod 25 MG/ML Topical Cream [Zyclara]?
In 2023, total Medicare Part D spending on imiquimod 25 MG/ML Topical Cream [Zyclara] 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.