Azelastine / fluticasone nasal spray (Dymista and others)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Seasonal allergic rhinitis (seasonal allergies that affect the nose) in adults and children 6 years of age and older. It relieves allergy symptoms in the nose.

What it is for, in depth

Dymista is a combination nasal spray for relief of the symptoms of seasonal allergic rhinitis in adults and children 6 years and older. Seasonal allergic rhinitis is the stuffy, runny, itchy nose and sneezing caused by seasonal allergies. The spray combines an antihistamine (azelastine hydrochloride) and a corticosteroid (fluticasone propionate) in one fixed-dose product, so a person who needs both kinds of treatment can get them in a single spray instead of two separate sprays. It comes as a metered spray: each spray delivers 137 mcg of azelastine hydrochloride (equal to 125 mcg of azelastine base) and 50 mcg of fluticasone propionate, and the 23 g bottle provides 120 metered sprays after priming. The usual dose is 1 spray per nostril twice daily, for nasal use only.

How it works

This spray combines two medicines. Azelastine is an antihistamine that blocks histamine H1 receptors, which helps stop allergy symptoms. Fluticasone propionate is a corticosteroid (steroid) that calms inflammation. Together they treat nose allergy symptoms in two different ways.

How it is taken

It is a nasal spray for use in the nose only. The usual dose is 1 spray in each nostril twice a day. Prime the spray before the first use and again if it has not been used for 14 or more days. Each spray has 137 mcg of azelastine hydrochloride and 50 mcg of fluticasone propionate. The bottle gives 120 sprays and should be thrown away after 120 sprays are used.

Common side effects

The label lists sleepiness (somnolence) and nose problems such as nosebleeds (epistaxis), sores in the nose (nasal ulceration), and a hole in the wall between the nostrils (nasal septal perforation). Tell your doctor if nosebleeds or sores keep happening.

Serious warnings

This spray can make you sleepy, so do not drive or use machines until you know how it affects you. It can also raise eye pressure and worsen glaucoma or cataracts, slow growth in children, weaken the immune system so infections get worse, and, at very high doses or in sensitive people, cause too much steroid effect (hypercorticism) and adrenal suppression. Do not use it if you have had a serious allergic reaction (including anaphylaxis) to azelastine, fluticasone, or any ingredient in the spray.

Who should be careful

People with recent nose ulcers, nose surgery, or nose injury should avoid it until healed. People with glaucoma, cataracts, raised eye pressure, tuberculosis, untreated fungal, bacterial, viral, or parasitic infections, or eye herpes should be watched closely. Children using it should have their growth checked regularly. People who have never had chickenpox or measles should be careful, because these illnesses can be more serious while using a steroid spray.

Major interactions

The label says no formal drug interaction studies were done with this combination spray, and any interactions are expected to match those of its two ingredients. Do not drink alcohol or take other medicines that slow the central nervous system while using it, because that can make you even less alert.

Cost and saving notes

If your Medicare Part D plan charges a lot for this drug, you can ask the plan for a tier exception to move it to a lower cost tier, with a letter from your doctor explaining why you need it. If you have low income, Extra Help (the Part D Low Income Subsidy) can lower your premiums and drug costs. You can apply for Extra Help through Social Security at any time.

Why it is in its tier

Azelastine / fluticasone nasal spray (Dymista and others) sits on Tier 4 in 64.0% of the plans that list it (112 of 175 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $331 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. Only 3.18% of Part D plans list it at all, so many readers will find their plan does not list it and covers a similar drug instead. The tier shown is the most common one; individual plans vary.

Sources

• DYMISTA (AZELASTINE HYDROCHLORIDE AND FLUTICASONE PROPIONATE) SPRAY, METERED [VIATRIS SPECIALTY LLC] — DailyMed
• MedlinePlus — Azelastine Nasal Spray

What official patient guides say

Scope note: MedlinePlus has no patient page for the azelastine-fluticasone combination (Dymista), so this context comes from the MedlinePlus page for the first-named ingredient, Azelastine Nasal Spray, and covers azelastine nasal spray use only, not the fluticasone part of the combination. Azelastine comes as a liquid to spray in the nose, sprayed in each nostril one or two times a day, and it should be used exactly as directed — do not use more or less of it or use it more often than your doctor prescribed. It is for use in the nose only: do not swallow it or spray it into your eyes or mouth, and each bottle should be used by only one person and not shared, because sharing may spread germs; an adult should help children younger than 12 years old use it. Before the first use, remove the cap and safety clip and prime the pump by pressing down and releasing it up to four times, pointed upright and away from your face, until a fine mist appears, and reprime with 2 sprays or until a fine mist appears if you have not used it for more than 3 days; then blow your nose, close one nostril with a finger, tilt your head slightly forward, insert the tip into the other nostril, press firmly down to release a spray while breathing gently in through that nostril, repeat in the second nostril (and repeat if your doctor told you to use two sprays in each nostril), then wipe the applicator with a clean tissue and replace the cap and safety clip. If you forget a dose, use it as soon as you remember it, unless it is almost time for the next dose, in which case skip the missed dose and continue your regular schedule; do not use a double dose to make up for a missed one. Keep it in the container it came in, tightly closed and out of the sight and reach of children, stored at room temperature away from excess heat and moisture (not in the bathroom).

Source: MedlinePlus — Azelastine Nasal Spray

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 2.07032 per unit (AZELASTIN-FLUTIC 137-50 MCG SPR) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 175 list Azelastine / fluticasone nasal spray (Dymista and others) — 3.2% of plans. Most of those plans put it on Tier 4: 112 plans, 64% of the plans that list it. Other plans place it on Tier 2 (41 plans), Tier 3 (21 plans) or Tier 1 (1 plans). For example: Univera SeniorChoice Secure (HMO-POS) puts it on Tier 3; Medicare Blue Choice Optimum (HMO-POS) puts it on Tier 3; Univera SeniorChoice Value Plus (HMO-POS) puts it on Tier 3. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.