ruxolitinib 15 MG/ML Topical Cream [Opzelura]
ruxolitinib
RxCUI: 2570757
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 |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC FOR YOU, INC | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Premier Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life PPO Essential Care Rx (PPO) | UPMC HEALTH NETWORK, INC. | T5 | Yes | $0 | PA |
| UPMC for Life Complete Care (HMO D-SNP) | UPMC HEALTH COVERAGE, INC. | T5 | Yes | $0 | PA |
| Kaiser Permanente Senior Advantage LA, Orange Co. (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Solano (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Inland Empire (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Marin San Mateo (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Ventura (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Kern (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Kern (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage San Diego (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Enhanced Stanis (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Stanis (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic SnJoaq (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Fresno (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Advantage Basic Sac., Sonoma (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Santa Cruz (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Alameda (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic SF (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Adv Basic Contra Costa (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Adv Basic Santa Clara (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic Solano (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage Basic San Mateo (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Advantage LA, Orange Value (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Sr Advantage Inland Empire Value (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
| Kaiser Permanente Senior Advantage San Diego Value (HMO) | KAISER FOUNDATION HP, INC. | T5 | No | $0 | CA |
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.