Yes, Medicare covers fluorouracil in both its topical and injectable forms, but the part of Medicare that pays depends on how the drug is administered. Topical fluorouracil cream, used for precancerous skin growths and certain skin cancers, is typically covered under Medicare Part D. Injectable fluorouracil, used in chemotherapy, is covered under Medicare Part B when administered in a doctor’s office, hospital outpatient setting, or at home through an infusion pump.
Part B vs. Part D: Which One Covers Your Prescription
The distinction matters because Part B and Part D work very differently in terms of what you pay. Medicare Part B covers fluorouracil when it’s given intravenously, either in a clinical setting or at home using a portable infusion pump. CMS specifically lists fluorouracil as a drug that qualifies for Part B coverage when administered through durable medical equipment like an infusion pump in the home setting. Under Part B, you pay 20% of the Medicare-approved amount after meeting your annual deductible, which is $257 in 2025.
Topical fluorouracil cream, sold under brand names like Efudex and Tolak, falls under Medicare Part D because it’s a self-administered prescription you pick up at a pharmacy. Part D is the prescription drug benefit, and coverage specifics vary by plan. Your cost depends on which formulary tier your plan places fluorouracil on, your plan’s copay or coinsurance structure, and which pharmacy you use.
What Conditions Qualify for Coverage
Topical fluorouracil is approved to treat actinic keratosis (rough, scaly patches caused by years of sun exposure) and superficial basal cell carcinoma, a common form of skin cancer. These are the standard indications that Part D plans cover.
Injectable fluorouracil is one of the most widely used chemotherapy drugs and treats several cancers, including colorectal, breast, stomach, and pancreatic cancers. Medicare Part B covers it as part of chemotherapy regimens for these conditions. There’s also a less common use: fluorouracil can be used during eye surgery for glaucoma patients at high risk of filtering surgery failure, which Medicare recognizes as a covered indication.
Home Infusion Coverage Under Part B
Many cancer treatment plans involve fluorouracil delivered continuously over 46 to 48 hours through a small portable pump you wear at home. Medicare Part B covers the pump itself as durable medical equipment, along with supplies like IV tubing and catheters. It also covers home infusion therapy services, which include nursing visits, caregiver training, and patient monitoring to make sure the infusion goes safely.
For all of this, the standard Part B cost-sharing applies: 20% coinsurance after your $257 annual deductible. If you have a Medigap supplemental policy, it may cover some or all of that 20%.
What Topical Fluorouracil Costs Out of Pocket
A tube of generic fluorouracil cream typically costs between $35 and $75 at retail pharmacies before insurance. With a Part D plan, your actual copay depends on the plan’s formulary. Generic fluorouracil is generally placed on a lower tier than brand-name versions, which means lower copays. If your plan uses a tiered structure, expect to pay less for generic fluorouracil than you would for Efudex or another brand-name version.
Because Part D plans vary widely, it’s worth checking your specific plan’s formulary before filling the prescription. You can do this through Medicare’s plan finder tool or by calling your plan directly. Switching to a preferred pharmacy in your plan’s network can also reduce costs.
Financial Help for Medicare Patients
If cost is a barrier, pharmaceutical manufacturers sometimes offer patient assistance programs that provide free or discounted medication to low-income individuals. Medicare patients enrolled in Part D can use these programs, but there’s an important catch: any assistance from a manufacturer program doesn’t count toward your true out-of-pocket spending under Part D. That means it won’t help you reach the catastrophic coverage threshold where your costs drop significantly.
Medicare’s Extra Help program (also called the Low-Income Subsidy) is another option if your income and resources are limited. It can substantially reduce Part D premiums, deductibles, and copays. State Pharmaceutical Assistance Programs may also supplement Part D coverage depending on where you live.