Medicare Part D coverage · sirolimus · RxCUI 2596869
sirolimus 0.002 MG/MG Topical Gel [Hyftor]
Per the CMS 2026 Part D formulary file, sirolimus 0.002 MG/MG Topical Gel [Hyftor] is covered by 107 Medicare Part D plans (2.1% of enrollable products), averaging Tier 4.6, with prior authorization required on 100% of covering formularies.
- 2.1%
- Plan coverage
- 107
- Plans covering
- T4.6
- Avg tier
- 100%
- Prior auth required
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 |
Show the next 30 plans
| 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 |
Showing top 50 of 100 plans.
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.
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
- 12 HR treprostinil 0.25 MG Extended Release Oral Tablet [Orenitram] T4.6
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- 0.375 ML leuprolide acetate 120 MG/ML Prefilled Syringe [Vabrinty] T4.6
- 0.5 ML leuprolide acetate 60 MG/ML Prefilled Syringe [Vabrinty] T4.6
Similar prior-authorization rate
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