Medicare Part D coverage · ruxolitinib · RxCUI 2570757
ruxolitinib 15 MG/ML Topical Cream [Opzelura]
Per the CMS 2026 Part D formulary file, ruxolitinib 15 MG/ML Topical Cream [Opzelura] is covered by 171 Medicare Part D plans (3.4% of enrollable products), averaging Tier 5, with prior authorization required on 77.8% of covering formularies.
- 3.4%
- Plan coverage
- 171
- Plans covering
- T5
- Avg tier
- 77.8%
- Prior auth required
What the CMS Formulary Data Shows for ruxolitinib 15 MG/ML Topical Cream [Opzelura]
Per the CMS 2026 Part D formulary file, ruxolitinib 15 MG/ML Topical Cream [Opzelura] (RxNorm concept RXCUI 2570757, generic name ruxolitinib) appears on 9 distinct formulary files spanning 171 Medicare Part D plan offerings - 3.4% 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 ruxolitinib 15 MG/ML Topical Cream [Opzelura] depends on utilization management as much as tier placement: 77.8% of covering formularies require prior authorization. 0% require step therapy. 33.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 14,085 Part D beneficiaries filled ruxolitinib 15 MG/ML Topical Cream [Opzelura] in 2023, with total plan-and-beneficiary spending of $75,729,871 and an average per-beneficiary annual cost of $5,376.63. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry ruxolitinib 15 MG/ML Topical Cream [Opzelura] today.
Coverage Details
- Formularies covering
- 9
- Plans covering
- 171
- Coverage rate
- 3.4%
- Tier range
- Tier 5, Specialty
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 77.8% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 33.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 14,085
- Total spending
- $75,729,871
- Avg per beneficiary
- $5,376.63
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering ruxolitinib 15 MG/ML Topical Cream [Opzelura]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Medicare BlueEssential (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueActive (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare BlueVital (PPO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Basic (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Univera SeniorChoice Extra (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| Medicare Blue Choice Core (HMO) | Excellus Health Plan, Inc. | T5 | Yes | $0 | NY |
| HAP Medicare Explore (PPO) | Alliance Health AND Life Insurance Company | T5 | Yes | $0 | MI |
| HAP Medicare Prime (PPO) | Alliance Health AND Life Insurance Company | T5 | Yes | $0 | MI |
| HAP Medicare Connect (HMO) | Health Alliance Plan OF Michigan | T5 | Yes | $0 | MI |
| HAP Medicare Complete Duals (HMO D-SNP) | Health Alliance Plan OF Michigan | T5 | Yes | $0 | MI |
| HAP Medicare Superior (HMO) | Health Alliance Plan OF Michigan | T5 | Yes | $0 | MI |
| Henry Ford Select (HMO) | Health Alliance Plan OF Michigan | T5 | Yes | $0 | MI |
| Univera Medicare Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Medicare Blue Dual (HMO D-SNP) | Excellus Health Plan Community Care LLC | T5 | Yes | $0 | NY |
| Network Health Select (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Go (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Anywhere (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Choice (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| Network Health Zero (PPO) | Network Health Insurance Corporation | T5 | Yes | $0 | WI |
| UPMC for Life HMO Premier Rx (HMO) | Upmc Health Plan, Inc. | T5 | Yes | $0 | PA |
Show the next 30 plans
Showing top 50 of 100 plans.
Frequently Asked Questions
Is ruxolitinib 15 MG/ML Topical Cream [Opzelura] covered by Medicare Part D?
Yes, ruxolitinib 15 MG/ML Topical Cream [Opzelura] is covered by 171 Medicare Part D plans (3.4% of all Part D formularies).
What tier is ruxolitinib 15 MG/ML Topical Cream [Opzelura] on Medicare Part D plans?
ruxolitinib 15 MG/ML Topical Cream [Opzelura] averages Tier 5 across Part D plans, ranging from Tier 5 to Tier 5.
Does ruxolitinib 15 MG/ML Topical Cream [Opzelura] require prior authorization?
77.8% of Part D formularies require prior authorization for ruxolitinib 15 MG/ML Topical Cream [Opzelura]. Step therapy: 0%. Quantity limits: 33.3%.
How much does Medicare spend on ruxolitinib 15 MG/ML Topical Cream [Opzelura]?
In 2023, total Medicare Part D spending on ruxolitinib 15 MG/ML Topical Cream [Opzelura] was $75,729,871, covering 14,085 beneficiaries. The average spend per beneficiary was $5,376.63.
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.
Closest average formulary tier
- 0.8 ML adalimumab-adaz 100 MG/ML Auto-Injector T5
- metronidazole 10 MG/ML Topical Cream [Noritate] T5
- 1 ML ustekinumab-ttwe 90 MG/ML Prefilled Syringe T5
- formoterol fumarate 0.01 MG/ML Inhalation Solution [Perforomist] T5
- deferiprone 1000 MG Oral Tablet [Ferriprox] T5
- cyclosporine 1 MG/ML Ophthalmic Suspension [Verkazia] T5
Similar prior-authorization rate
- deferiprone 100 MG/ML Oral Solution [Ferriprox] 77.8% PA
- {14 (dimethyl fumarate 120 MG Delayed Release Oral Capsule) / 46 (dimethyl fumarate 240 MG Delayed Release Oral Capsule) } Pack 77.7% PA
- vigabatrin 500 MG Powder for Oral Solution 77.7% PA
- 0.5 ML peginterferon beta-1a 0.25 MG/ML Prefilled Syringe [Plegridy] 77.5% PA
- 1.5 ML leuprolide acetate 7.5 MG/ML Prefilled Syringe [Lupron] 77.5% PA
- vigabatrin 500 MG Oral Tablet 77.4% PA