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pramoxine hydrochloride hydrocortisone acetate 100 mg/10g / 100 mg/10g Medicare Part D Coverage

Brand name: PROCTOFOAM HC HC
Dosage form
AEROSOL, FOAM
Route
TOPICAL
Drug class
Corticosteroids — Systemic
3%
of Medicare Part D plans
cover pramoxine hydrochloride hydrocortisone acetate
167 of 5,530 plans
2.4
Avg. formulary tier
$12.00
Median 30-day copay
$0.00–$24.00
Copay range

Formulary Tier Distribution

How Medicare Part D plans classify pramoxine hydrochloride hydrocortisone acetate. Lower tiers = lower copays.

Tier 1 - Preferred Generic 7%
11 plans • avg $0.00/mo
Tier 2 - Generic 69%
115 plans • avg $3.33/mo
Tier 3 - Preferred Brand 4%
6 plans • avg $0.00/mo
Tier 4 - Non-Preferred Drug 21%
35 plans • avg $0.00/mo

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pramoxine hydrochloride hydrocortisone acetate Medicare Coverage by State

Coverage rates and average costs vary significantly by state. Click a state to see the specific plans available there.

Arkansas 100% California 100% Colorado 100% District of Columbia 100% Georgia 100% Hawaii 100% Indiana 100% Kentucky 100% Maryland 100% avg $24.00 New Mexico 100% New York 100% Ohio 100% Oregon 100% avg $20.00 Pennsylvania 100% Tennessee 100% Texas 100% Virginia 100% Washington 100% avg $20.00 West Virginia 100%

Alternative Medications in the Same Drug Class

Other drugs in the Corticosteroids — Systemic that Medicare Part D plans also cover.

Dexamethasone Avg Tier 2.3 $15.00/mo 5,529 plans PredniSONE Avg Tier 1.1 $18.00/mo 5,529 plans PredniSONE Avg Tier 1.1 $18.00/mo 5,529 plans Dexamethasone Avg Tier 2.3 $15.00/mo 5,529 plans Dexamethasone Avg Tier 2.3 $15.00/mo 5,529 plans Hydrocortisone Avg Tier 1.9 $15.00/mo 5,529 plans Prednisone Avg Tier 1.1 $18.00/mo 5,529 plans PredniSONE Avg Tier 1.1 $18.00/mo 5,529 plans

Frequently Asked Questions about pramoxine hydrochloride hydrocortisone acetate

3% of Medicare Part D plans cover pramoxine hydrochloride hydrocortisone acetate. It is most commonly placed on Tier 2. Coverage varies by plan and geographic area.

The median 30-day copay for pramoxine hydrochloride hydrocortisone acetate on Medicare Part D is $12.00 at a preferred pharmacy. Costs range from $0.00 to $24.00 depending on the plan.

pramoxine hydrochloride hydrocortisone acetate is placed on Tier 2 by most Medicare Part D plans. Lower tier numbers generally mean lower copays.

0% of plans require prior authorization for pramoxine hydrochloride hydrocortisone acetate. Prior authorization means your doctor must confirm the drug is medically necessary before the plan will cover it.

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Coverage statistics based on CMS formulary data for plan year 2026. Data updated regularly. Methodology →