sirolimus 0.002 MG/MG Topical Gel [Hyftor]
sirolimus
RxCUI: 2596869
What the CMS Formulary Data Shows for sirolimus 0.002 MG/MG Topical Gel [Hyftor]
Per the CMS 2026 Part D formulary file, sirolimus 0.002 MG/MG Topical Gel [Hyftor] (RxNorm concept RXCUI 2596869, generic name sirolimus) appears on 23 distinct formulary files spanning 107 Medicare Part D plan offerings - 2.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.6.
Real-world access to sirolimus 0.002 MG/MG Topical Gel [Hyftor] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 17.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 7,218 Part D beneficiaries filled sirolimus 0.002 MG/MG Topical Gel [Hyftor] in 2023, with total plan-and-beneficiary spending of $22,534,921 and an average per-beneficiary annual cost of $3,122.04. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry sirolimus 0.002 MG/MG Topical Gel [Hyftor] today.
Coverage Details
- Formularies covering
- 23
- Plans covering
- 107
- Coverage rate
- 2.1%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 5, Specialty
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 17.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 7,218
- Total spending
- $22,534,921
- Avg per beneficiary
- $3,122.04
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering sirolimus 0.002 MG/MG Topical Gel [Hyftor]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| SeniorCare Complete (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | SOUTH COUNTRY HEALTH ALLIANCE | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | ALAMEDA ALLIANCE FOR HEALTH | T1 | Yes | $0 | CA |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T5 | Yes | $0 | NV |
| 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 |
| 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 |
| Geisinger Gold Preferred Complete Rx (PPO) | GEISINGER INDEMNITY INSURANCE COMPANY | T5 | Yes | $0 | PA |
| Geisinger Gold Secure Rx (HMO D-SNP) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic 360 Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| Geisinger Gold Classic Essential Rx (HMO) | GEISINGER HEALTH PLAN | T5 | Yes | $0 | PA |
| MCS Classicare RxMax (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Ideal (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Efectivo (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Essential (HMO-POS) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Progreso (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Primero (HMO C-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Firme (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare En Tu Hogar (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Hero (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Total (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare InteliCare (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Maximo (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Excede (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Estrella (HMO) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino Superior (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| MCS Classicare Platino 185 (HMO D-SNP) | MCS ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Troy Medicare (HMO) | TROY HEALTH, INC. | T5 | Yes | $0 | NC |
Frequently Asked Questions
Is sirolimus 0.002 MG/MG Topical Gel [Hyftor] covered by Medicare Part D?
Yes, sirolimus 0.002 MG/MG Topical Gel [Hyftor] is covered by 107 Medicare Part D plans (2.1% of all Part D formularies).
What tier is sirolimus 0.002 MG/MG Topical Gel [Hyftor] on Medicare Part D plans?
sirolimus 0.002 MG/MG Topical Gel [Hyftor] averages Tier 4.6 across Part D plans, ranging from Tier 1 to Tier 6.
Does sirolimus 0.002 MG/MG Topical Gel [Hyftor] require prior authorization?
100% of Part D formularies require prior authorization for sirolimus 0.002 MG/MG Topical Gel [Hyftor]. Step therapy: 0%. Quantity limits: 17.4%.
How much does Medicare spend on sirolimus 0.002 MG/MG Topical Gel [Hyftor]?
In 2023, total Medicare Part D spending on sirolimus 0.002 MG/MG Topical Gel [Hyftor] was $22,534,921, covering 7,218 beneficiaries. The average spend per beneficiary was $3,122.04.
Read our methodology - how this data is sourced, computed, and verified.