lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution
lidocaine hydrochloride
RxCUI: 1010878
What the CMS Formulary Data Shows for lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution
Per the CMS 2026 Part D formulary file, lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution (RxNorm concept RXCUI 1010878, generic name lidocaine hydrochloride) appears on 228 distinct formulary files spanning 3,215 Medicare Part D plan offerings - 63.4% 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 2.4.
Real-world access to lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution depends on utilization management as much as tier placement: 47.8% of covering formularies require prior authorization. 0% require step therapy. 64.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 25,210 Part D beneficiaries filled lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution in 2023, with total plan-and-beneficiary spending of $429,331 and an average per-beneficiary annual cost of $17.03. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution today.
Coverage Details
- Formularies covering
- 228
- Plans covering
- 3,215
- Coverage rate
- 63.4%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 47.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 64.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 25,210
- Total spending
- $429,331
- Avg per beneficiary
- $17.03
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution
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 |
| Freedom VIP Care (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Platinum Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Gold Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Gold Plus Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T1 | Yes | $0 | FL |
| 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 |
Frequently Asked Questions
Is lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution covered by Medicare Part D?
Yes, lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution is covered by 3,215 Medicare Part D plans (63.4% of all Part D formularies).
What tier is lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution on Medicare Part D plans?
lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution averages Tier 2.4 across Part D plans, ranging from Tier 1 to Tier 4.
Does lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution require prior authorization?
47.8% of Part D formularies require prior authorization for lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution. Step therapy: 0%. Quantity limits: 64.5%.
How much does Medicare spend on lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution?
In 2023, total Medicare Part D spending on lidocaine hydrochloride 40 MG/ML Mucous Membrane Topical Solution was $429,331, covering 25,210 beneficiaries. The average spend per beneficiary was $17.03.
Read our methodology - how this data is sourced, computed, and verified.