lidocaine 0.05 MG/MG Topical Ointment
lidocaine
RxCUI: 1543069
What the CMS Formulary Data Shows for lidocaine 0.05 MG/MG Topical Ointment
Per the CMS 2026 Part D formulary file, lidocaine 0.05 MG/MG Topical Ointment (RxNorm concept RXCUI 1543069, generic name lidocaine) appears on 284 distinct formulary files spanning 3,955 Medicare Part D plan offerings - 78.1% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.6.
Real-world access to lidocaine 0.05 MG/MG Topical Ointment depends on utilization management as much as tier placement: 69.4% of covering formularies require prior authorization. 0% require step therapy. 93.7% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 481,042 Part D beneficiaries filled lidocaine 0.05 MG/MG Topical Ointment in 2023, with total plan-and-beneficiary spending of $179,454,361 and an average per-beneficiary annual cost of $373.05. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lidocaine 0.05 MG/MG Topical Ointment today.
Coverage Details
- Formularies covering
- 284
- Plans covering
- 3,955
- Coverage rate
- 78.1%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 69.4% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 93.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 481,042
- Total spending
- $179,454,361
- Avg per beneficiary
- $373.05
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lidocaine 0.05 MG/MG Topical Ointment
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | SENTARA HEALTH PLANS | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | HPMP OF FLORIDA, INC. | T1 | Yes | $0 | FL |
| ElderServe MAP (HMO D-SNP) | ELDERSERVE HEALTH, INC. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | GROUP HEALTH COOPERATIVE OF EAU CLAIRE | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP | T1 | No | $0 | NJ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | MERCY CARE | T1 | Yes | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | ELDERPLAN, INC. | T1 | Yes | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | HEALTH CHOICE ARIZONA, INC. | T1 | Yes | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | HEALTHFIRST HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| IMCare Classic (HMO D-SNP) | ITASCA MEDICAL CARE | T1 | Yes | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | HOPKINS HEALTH ADVANTAGE, INC. | T1 | Yes | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | METROPLUS HEALTH PLAN, INC. | T1 | Yes | $0 | NY |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | UPPER PENINSULA HEALTH PLAN, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | CARESOURCE GEORGIA CO. | T1 | No | $0 | GA |
| Senior Whole Health SCO (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| Molina One Care (HMO D-SNP) | SENIOR WHOLE HEALTH, LLC | T1 | Yes | $0 | MA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP CARESOURCE | T1 | No | $0 | MI |
| PruittHealth Premier D-SNP (HMO D-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | Yes | $0 | GA |
| KeyCare Advantage Plus (HMO C-SNP) | ISNP VENTURES, LLC | T1 | Yes | $0 | MD |
| Premier Care (HMO-POS I-SNP) | LIFEWORKS ADVANTAGE, LLC | T1 | Yes | $0 | VA |
| Premier Care (HMO I-SNP) | ALIGN SENIOR CARE CALIFORNIA INC. | T1 | Yes | $0 | CA |
| Advantage Care (HMO) | ALIGN SENIOR CARE CALIFORNIA INC. | T1 | Yes | $0 | CA |
| Premier Care (HMO-POS I-SNP) | ALIGN SENIOR CARE MI, LLC | T1 | Yes | $0 | MI |
| Premier Care (HMO I-SNP) | ALIGN SENIOR CARE FLORIDA, INC. | T1 | Yes | $0 | FL |
| Perennial Advantage Freedom (HMO-POS) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | Yes | $0 | CO |
| Perennial Advantage Premier (HMO-POS I-SNP) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | Yes | $0 | CO |
| Perennial Advantage Freedom (HMO) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | Yes | $0 | PA |
| Perennial Advantage Premier (HMO I-SNP) | PERENNIAL ADVANTAGE OF COLORADO, INC. | T1 | Yes | $0 | PA |
| Perennial Advantage Freedom (HMO-POS) | PERENNIAL ADVANTAGE OF OHIO, INC. | T1 | Yes | $0 | OH |
| Perennial Advantage Premier (HMO-POS I-SNP) | PERENNIAL ADVANTAGE OF OHIO, INC. | T1 | Yes | $0 | OH |
| ProCare Advantage - Diabetes Care Management (HMO-POS C-SNP) | PROCARE ADVANTAGE, LLC | T1 | Yes | $0 | TX |
| PruittHealth Premier Advantage (HMO I-SNP) | PRUITTHEALTH PREMIER, INC. | T1 | Yes | $0 | GA |
| Senior Health Plan Silver Plus (HMO) | COMMUNITYCARE GOVERNMENT PROGRAMS, INC. | T1 | Yes | $0 | OK |
| Senior Health Plan Oklahoma Dual Complete (HMO D-SNP) | COMMUNITYCARE GOVERNMENT PROGRAMS, INC. | T1 | Yes | $0 | OK |
| Community First Medicare Advantage Alamo Plan (HMO) | COMMUNITY FIRST HEALTH PLANS, INC. | T1 | Yes | $0 | TX |
| Community First Medicare Advantage D-SNP (HMO D-SNP) | COMMUNITY FIRST HEALTH PLANS, INC. | T1 | Yes | $0 | TX |
| Community DualCare Aligned (HMO D-SNP) | COMMUNITY HEALTH CHOICE TEXAS, INC. | T1 | Yes | $0 | TX |
| Community DualCare Access (HMO D-SNP) | COMMUNITY HEALTH CHOICE TEXAS, INC. | T1 | Yes | $0 | TX |
| El Paso Health Medicare Advantage Dual (HMO D-SNP) | EL PASO FIRST HEALTH PLANS, INC. | T1 | Yes | $0 | TX |
| El Paso Health Total (HMO) | EL PASO FIRST HEALTH PLANS, INC. | T1 | Yes | $0 | TX |
| El Paso Health Giveback (HMO) | EL PASO FIRST HEALTH PLANS, INC. | T1 | Yes | $0 | TX |
| Liberty Medicare Advantage (HMO C-SNP) | LIBERTY ADVANTAGE, LLC | T1 | Yes | $0 | NC |
| Peak Advantage Vista (PPO) | PEAK HEALTH INSURANCE CORPORATION | T1 | Yes | $0 | PA, WV |
| SECUR Edge (HMO I-SNP) | SECUR INC | T1 | Yes | $0 | FL |
| Simpra Advantage Dual Care (PPO D-SNP) | SIMPRA ADVANTAGE, INC. | T1 | Yes | $0 | AL |
| CareAdvantage (HMO D-SNP) | SAN MATEO HEALTH COMMISSION | T1 | No | $0 | CA |
Frequently Asked Questions
Is lidocaine 0.05 MG/MG Topical Ointment covered by Medicare Part D?
Yes, lidocaine 0.05 MG/MG Topical Ointment is covered by 3,955 Medicare Part D plans (78.1% of all Part D formularies).
What tier is lidocaine 0.05 MG/MG Topical Ointment on Medicare Part D plans?
lidocaine 0.05 MG/MG Topical Ointment averages Tier 2.6 across Part D plans, ranging from Tier 1 to Tier 4.
Does lidocaine 0.05 MG/MG Topical Ointment require prior authorization?
69.4% of Part D formularies require prior authorization for lidocaine 0.05 MG/MG Topical Ointment. Step therapy: 0%. Quantity limits: 93.7%.
How much does Medicare spend on lidocaine 0.05 MG/MG Topical Ointment?
In 2023, total Medicare Part D spending on lidocaine 0.05 MG/MG Topical Ointment was $179,454,361, covering 481,042 beneficiaries. The average spend per beneficiary was $373.05.
Read our methodology - how this data is sourced, computed, and verified.