pimecrolimus 10 MG/ML Topical Cream [Elidel]
pimecrolimus
RxCUI: 352085
What the CMS Formulary Data Shows for pimecrolimus 10 MG/ML Topical Cream [Elidel]
Per the CMS 2026 Part D formulary file, pimecrolimus 10 MG/ML Topical Cream [Elidel] (RxNorm concept RXCUI 352085, generic name pimecrolimus) appears on 2 distinct formulary files spanning 12 Medicare Part D plan offerings - 0.2% 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 2.5.
Real-world access to pimecrolimus 10 MG/ML Topical Cream [Elidel] depends on utilization management as much as tier placement: 50% 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 35,813 Part D beneficiaries filled pimecrolimus 10 MG/ML Topical Cream [Elidel] in 2023, with total plan-and-beneficiary spending of $19,388,132 and an average per-beneficiary annual cost of $541.37. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry pimecrolimus 10 MG/ML Topical Cream [Elidel] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 12
- Coverage rate
- 0.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 50% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 35,813
- Total spending
- $19,388,132
- Avg per beneficiary
- $541.37
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering pimecrolimus 10 MG/ML Topical Cream [Elidel]
12 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Health First Rewards H1099-014 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First SunSaver H1099-016 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Complete Care H1099-023 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-024 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Premier Access H1099-025 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-026 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Premier Access H1099-027 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Emerald Plus H1099-028 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $0 | FL |
| Health First Value H1099-006 (HMO) | HEALTH FIRST HEALTH PLANS | T4 | No | $15.00 | FL |
| Health First Classic H1099-001 (HMO-POS) | HEALTH FIRST HEALTH PLANS | T4 | No | $49.40 | FL |
Frequently Asked Questions
Is pimecrolimus 10 MG/ML Topical Cream [Elidel] covered by Medicare Part D?
Yes, pimecrolimus 10 MG/ML Topical Cream [Elidel] is covered by 12 Medicare Part D plans (0.2% of all Part D formularies).
What tier is pimecrolimus 10 MG/ML Topical Cream [Elidel] on Medicare Part D plans?
pimecrolimus 10 MG/ML Topical Cream [Elidel] averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does pimecrolimus 10 MG/ML Topical Cream [Elidel] require prior authorization?
50% of Part D formularies require prior authorization for pimecrolimus 10 MG/ML Topical Cream [Elidel]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on pimecrolimus 10 MG/ML Topical Cream [Elidel]?
In 2023, total Medicare Part D spending on pimecrolimus 10 MG/ML Topical Cream [Elidel] was $19,388,132, covering 35,813 beneficiaries. The average spend per beneficiary was $541.37.
Read our methodology - how this data is sourced, computed, and verified.