Butalbital / acetaminophen / caffeine (Fioricet, Esgic, and others)

How Medicare covers it

Part D (tablets and capsules taken at home taken 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

Relief of the symptom complex of tension headache (also called muscle contraction headache). The label is plain about the limits: evidence supporting the efficacy and safety of this combination product in the treatment of multiple recurrent headaches is unavailable, and caution is required because butalbital is habit-forming and potentially abusable.

What it is for, in depth

Fioricet is an as-needed combination pain reliever for the symptom complex of tension (muscle contraction) headache — it brings together a barbiturate sedative (butalbital), a pain and fever reliever (acetaminophen), and a stimulant (caffeine) in one capsule. It fits in the treatment path as a short-term, take-when-a-headache-strikes medicine, not a daily or long-term one: the label says evidence for its efficacy and safety in multiple recurrent headaches is unavailable, warns that butalbital is habit-forming and potentially abusable, and says extended and repeated use is not recommended because of the potential for physical dependence. The label product is a hard gelatin capsule containing 50 mg butalbital, 300 mg acetaminophen, and 40 mg caffeine, supplied in bottles of 100, taken as 1 or 2 capsules every 4 hours as needed with a maximum of 6 capsules a day. This medication package also covers the other forms matched in the CMS formulary file: a capsule and a tablet each containing 50 mg butalbital, 325 mg acetaminophen, and 40 mg caffeine.

How it works

This is a fixed combination of three drugs, and the label says the role each part plays in relieving the symptom complex known as tension headache is incompletely understood. Butalbital is a short- to intermediate-acting barbiturate (a sedative). Acetaminophen is a non-opiate, non-salicylate pain reliever and fever reducer (analgesic and antipyretic). Caffeine is a central nervous system stimulant.

How it is taken

Take 1 or 2 capsules by mouth every 4 hours as needed. The total daily dosage should not exceed 6 capsules. The label says extended and repeated use of this product is not recommended because of the potential for physical dependence. The capsule in this label contains 50 mg butalbital, 300 mg acetaminophen, and 40 mg caffeine.

Common side effects

The most frequently reported adverse reactions are drowsiness, lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, abdominal pain, and an intoxicated feeling. Less frequent effects include headache, a shaky feeling, tingling, agitation, fainting, fatigue, heavy eyelids, high energy, hot spells, numbness, sluggishness, seizure, dry mouth, increased sweating (hyperhidrosis), difficulty swallowing, heartburn, flatulence (gas), constipation, fast heart rate (tachycardia), leg pain, muscle fatigue, increased urination (diuresis), itching, fever, earache, nasal congestion, ringing in the ears (tinnitus), euphoria, and allergic reactions.

Serious warnings

BOXED WARNING: acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most cases of liver injury are associated with acetaminophen doses that exceed 4,000 milligrams per day, and often involve more than one acetaminophen-containing product — so never add other acetaminophen products on top of this one without counting the total. Other serious warnings from the label: butalbital is habit-forming and potentially abusable, extended and repeated use is not recommended because of the potential for physical dependence, and the drug increases central nervous system depression when combined with alcohol and other sedating drugs. Mental confusion, excitement, or depression can occur, particularly in elderly or debilitated patients or with overdosage of butalbital, and seizures have been reported infrequently. Several cases of serious skin reactions, including toxic epidermal necrolysis and erythema multiforme, have been reported.

Boxed warning

Acetaminophen has been associated with cases of acute liver failure, at times resulting in liver transplant and death. Most of the cases of liver injury are associated with the use of acetaminophen at doses that exceed 4,000 milligrams per day, and often involve more than one acetaminophen-containing product.

Who should be careful

People with hypersensitivity or intolerance to any component of this product, and patients with porphyria, must NOT take it — those are the label's contraindications. Elderly or debilitated patients should be careful because mental confusion, excitement, or depression can occur due to intolerance, particularly in those patients. Anyone who drinks alcohol, takes other sedating medicines, or takes any other product containing acetaminophen (including over-the-counter cold and pain products) must review that use with their prescriber or pharmacist first.

Major interactions

Monoamine oxidase (MAO) inhibitors can enhance the central nervous system effects of butalbital. This product can enhance the effects of other narcotic analgesics, alcohol, general anesthetics, tranquilizers such as chlordiazepoxide, sedative-hypnotics, and other central nervous system depressants, causing increased CNS depression — in plain terms, combining it with alcohol or other sedating medicines can make you dangerously more sedated. Taking other acetaminophen-containing products at the same time raises the total acetaminophen dose toward the level linked in the boxed warning to acute liver failure.

Cost and saving notes

Medicare facts: this combination is sold as a generic capsule and tablet as well as under brand names such as Fioricet and Esgic, and the generic versions are the standard lower-cost form for this Part D medicine taken at home. Check which acetaminophen strength your prescription specifies (300 mg or 325 mg per capsule or tablet in the products matched for this package), because the forms are not assumed to be interchangeable without your prescriber's direction. If your own Part D plan places it on a higher tier than expected, you or your prescriber can ask the plan for a tier exception when the lower-tier options would not work as well for you. If you qualify for Extra Help (the Part D Low-Income Subsidy), your premiums and copays drop a lot. In 2027, what you pay out of pocket for covered Part D drugs is capped at $2,400 for the year, and the Medicare Prescription Payment Plan lets you spread those costs into monthly payments instead of paying large amounts at the pharmacy counter. Ask your pharmacist or your plan what you would actually pay before you fill.

Why it is in its tier

Butalbital / acetaminophen / caffeine (Fioricet, Esgic, and others) sits on Tier 3 in 42.15% of the plans that list it (1159 of 2750 listing plans). Tier 3 is the preferred brand tier — mid-level copays or coinsurance. The data-visible drivers: It is sold both as a brand product and in generic form, and the CMS dashboard puts its average Part D spending at about $121 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 50.05% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• FIORICET (BUTALBITAL, ACETAMINOPHEN, AND CAFFEINE) CAPSULE [ACTAVIS PHARMA, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Acetaminophen, Butalbital, and Caffeine

What official patient guides say

This combination comes as a capsule, a tablet, and a liquid to take by mouth. Take it every 4 hours as needed, exactly as directed. Do not take more than 6 tablets, capsules, or tablespoonsful in 1 day, and do not take a larger dose, take it more often, or take it for longer than your doctor prescribed. If you use the liquid, do not use a household spoon to measure your dose. Use the measuring cup or spoon that came with the medication, or a spoon made for measuring medication. Unless your doctor tells you otherwise, continue your normal diet. This medication is usually taken as needed. If your doctor has told you to take it regularly and you miss a dose, take it as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular schedule. Do not take a double dose to make up for a missed one. Keep it in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus — Acetaminophen, Butalbital, and Caffeine

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 0.3526 per unit (BUTALBITAL-ACETAMINOPHEN-CAFFEINE 50-300-40 MG CAPSULE) — 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, 2,750 list Butalbital / acetaminophen / caffeine (Fioricet, Esgic, and others) — 50.0% of plans. Most of those plans put it on Tier 3: 1,159 plans, 42.1% of the plans that list it. Other plans place it on Tier 2 (1,084 plans), Tier 4 (405 plans) or Tier 1 (102 plans). For example: Humana Total Complete (HMO) puts it on Tier 2; Humana Dual Integrated (HMO D-SNP) puts it on Tier 2; Humana Total Complete (HMO-POS) puts it on Tier 2. 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.