tretinoin 0.0004 MG/MG Topical Gel
tretinoin
RxCUI: 359050
What the CMS Formulary Data Shows for tretinoin 0.0004 MG/MG Topical Gel
Per the CMS 2026 Part D formulary file, tretinoin 0.0004 MG/MG Topical Gel (RxNorm concept RXCUI 359050, generic name tretinoin) appears on 15 distinct formulary files spanning 363 Medicare Part D plan offerings - 7.2% 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 3.3.
Real-world access to tretinoin 0.0004 MG/MG Topical Gel depends on utilization management as much as tier placement: 73.3% of covering formularies require prior authorization. 13.3% require step therapy. 33.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 91,688 Part D beneficiaries filled tretinoin 0.0004 MG/MG Topical Gel in 2023, with total plan-and-beneficiary spending of $22,953,956 and an average per-beneficiary annual cost of $250.35. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry tretinoin 0.0004 MG/MG Topical Gel today.
Coverage Details
- Formularies covering
- 15
- Plans covering
- 363
- Coverage rate
- 7.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 73.3% of formularies
- Step therapy required
- 13.3% of formularies
- Quantity limits
- 33.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 91,688
- Total spending
- $22,953,956
- Avg per beneficiary
- $250.35
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering tretinoin 0.0004 MG/MG Topical Gel
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Community Care's Partnership Program (HMO D-SNP) | COMMUNITY CARE HEALTH PLAN, INC. | T1 | No | $0 | WI |
| Freedom VIP Care (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Savings (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Rewards (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Savings (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Rewards (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Freedom Medi-Medi Partial (HMO D-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Medi-Medi Full (HMO D-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Optimum Emerald Partial (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Emerald Full (HMO D-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Medicare Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom VIP Savings COPD (HMO C-SNP) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Platinum Rewards Plan Rx (HMO) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Freedom Máximo (HMO-POS) | FREEDOM HEALTH, INC. | T2 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Platinum Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Gold Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Gold Rewards Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Savings COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Gold Plus Plan (HMO) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Optimum Diamond Rewards COPD (HMO C-SNP) | OPTIMUM HEALTHCARE, INC. | T2 | Yes | $0 | FL |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T2 | No | $0 | MS |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
Frequently Asked Questions
Is tretinoin 0.0004 MG/MG Topical Gel covered by Medicare Part D?
Yes, tretinoin 0.0004 MG/MG Topical Gel is covered by 363 Medicare Part D plans (7.2% of all Part D formularies).
What tier is tretinoin 0.0004 MG/MG Topical Gel on Medicare Part D plans?
tretinoin 0.0004 MG/MG Topical Gel averages Tier 3.3 across Part D plans, ranging from Tier 1 to Tier 4.
Does tretinoin 0.0004 MG/MG Topical Gel require prior authorization?
73.3% of Part D formularies require prior authorization for tretinoin 0.0004 MG/MG Topical Gel. Step therapy: 13.3%. Quantity limits: 33.3%.
How much does Medicare spend on tretinoin 0.0004 MG/MG Topical Gel?
In 2023, total Medicare Part D spending on tretinoin 0.0004 MG/MG Topical Gel was $22,953,956, covering 91,688 beneficiaries. The average spend per beneficiary was $250.35.
Read our methodology - how this data is sourced, computed, and verified.