Febuxostat (Uloric 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

Gout in adults — specifically, the long-term control of high uric acid in people with gout whose gout did not respond well enough to the highest tolerated dose of allopurinol, who cannot take allopurinol, or for whom allopurinol is not a good choice. It lowers uric acid to help prevent gout attacks; it does not treat an attack that is already happening.

What it is for, in depth

Uloric (febuxostat) is for the chronic (long-term) management of hyperuricemia — uric acid that is too high — in adults with gout. Gout is a painful type of arthritis in which uric acid builds up and forms crystals in the joints, causing sudden attacks of redness, swelling, pain, and heat. This drug is not a first try for everyone: it is prescribed for adults whose gout did not respond to a maximally titrated (highest properly adjusted) dose of allopurinol, who are intolerant to allopurinol, or for whom allopurinol is not advisable. In the treatment path it is the step after allopurinol, taken every day to keep uric acid low and prevent future attacks — it is used to prevent gout attacks, not to treat one once it starts, and it can take months before attacks ease off. Flares often increase during the first months, so a preventive flare drug is usually added for up to 6 months. It comes as tablets in two strengths: 40 mg and 80 mg, taken once daily.

How it works

Febuxostat is a xanthine oxidase inhibitor. Xanthine oxidase is a body enzyme that helps make uric acid. By blocking it, febuxostat lowers the amount of uric acid the body makes, which lowers blood uric acid levels and helps stop uric acid crystals from building up in the joints.

How it is taken

Tablet by mouth once a day, with or without food, at about the same time each day. Antacids do not change how it is taken. The starting dose is 40 mg once a day. If blood uric acid is still not below 6 mg/dL after 2 weeks, the dose goes up to 80 mg once a day. People with severe kidney impairment should not take more than 40 mg once a day. A preventive drug (such as an NSAID or colchicine) is recommended when starting, for up to the first 6 months, because gout flares often increase at first. Do not stop the drug just because a flare happens.

Common side effects

The most common side effects in studies were abnormal liver function blood tests, nausea, joint pain (arthralgia), and rash. Dizziness was also reported. Gout flares themselves often get more frequent in the first months of treatment, which is why a preventive flare medicine is usually given at the start.

Serious warnings

WARNING — CARDIOVASCULAR DEATH: In a large heart-outcomes study, gout patients who already had cardiovascular (heart and blood vessel) disease and were treated with Uloric died from cardiovascular causes at a higher rate than patients treated with allopurinol. Because of this risk, doctors must weigh the risks and benefits before prescribing Uloric or keeping a patient on it, and Uloric should only be used in patients who have not responded well enough to a maximally titrated dose of allopurinol, who cannot tolerate allopurinol, or for whom allopurinol treatment is not advisable. Call your doctor or get emergency help right away for chest pain, shortness of breath, a fast or irregular heartbeat, numbness or weakness on one side of the body, dizziness, fainting, slurred speech, sudden blurry vision, or a sudden severe headache. Other serious risks: liver failure, sometimes fatal, has been reported — if liver injury is found, the drug is stopped promptly and not restarted if the injury is confirmed and no other cause is found. Serious skin reactions, including Stevens-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis, have also been reported — stop the drug and seek care if a serious skin reaction is suspected.

Boxed warning

Gout patients with established cardiovascular (CV) disease treated with ULORIC had a higher rate of CV death compared to those treated with allopurinol in a CV outcomes study. Consider the risks and benefits of ULORIC when deciding to prescribe or continue patients on ULORIC. ULORIC should only be used in patients who have an inadequate response to a maximally titrated dose of allopurinol, who are intolerant to allopurinol, or for whom treatment with allopurinol is not advisable.

Who should be careful

People with established heart or blood vessel disease need an honest risk-benefit talk with their doctor first, because of the boxed warning on cardiovascular death. People with severe kidney impairment are limited to 40 mg once a day. No studies were done in people with severe liver impairment, so care is needed. This drug is not recommended for people with secondary high uric acid — including people treated for Lesch-Nyhan syndrome or cancer, or organ transplant recipients — because it was not studied in those groups. Tell your doctor if you have heart disease, a past heart attack or stroke, or kidney or liver problems, or if you are pregnant or breastfeeding.

Major interactions

Never take febuxostat while being treated with azathioprine or mercaptopurine — this combination is not allowed, because febuxostat can raise the levels of those drugs and cause severe toxicity. More broadly, febuxostat can raise the blood levels of other drugs broken down by xanthine oxidase, so tell your doctor and pharmacist about every medicine you take.

Cost and saving notes

Febuxostat is available as a generic under Medicare Part D, and the generic usually costs less than the brand name Uloric. Because this drug is a second-step treatment after allopurinol, your plan may require you to have tried allopurinol first — ask your plan or pharmacist what your plan requires and what the generic will cost you.

Why it is in its tier

Febuxostat (Uloric and others) sits on Tier 3 in 53.86% of the plans that list it (2530 of 4697 listing plans). Tier 3 is the preferred brand tier — mid-level copays or coinsurance. The data-visible drivers: It is a generic product, and the CMS dashboard puts its average Part D spending at about $448 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. It is listed by 85.48% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• ULORIC (FEBUXOSTAT) TABLET [TAKEDA PHARMACEUTICALS AMERICA, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Febuxostat

What official patient guides say

Febuxostat (Uloric) comes as a tablet to take by mouth. It is usually taken once a day, with or without food, at around the same time every day. Take it exactly as directed — do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may increase your dose after 2 weeks if a laboratory test shows that you still have too much uric acid in your blood. It may take several months before febuxostat begins to prevent gout attacks, and it may increase the number of gout attacks during the first few months of treatment; your doctor may prescribe another medication to prevent gout attacks during the first 6 months of treatment. Continue to take febuxostat even if you have gout attacks during your early treatment. Febuxostat controls gout but does not cure it. Continue to take it even if you feel well, and do not stop taking it without talking to your doctor. If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and continue your regular schedule. Do not take a double dose. Keep it in the container it came in, tightly closed and out of reach of children. Store it at room temperature, away from light, excess heat and moisture, and not in the bathroom.

Source: MedlinePlus — Febuxostat

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 0.18751 per unit (FEBUXOSTAT 40 MG TABLET) — 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 2026-11-08

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 4,697 list Febuxostat (Uloric and others) — 85.5% of plans. Most of those plans put it on Tier 3: 2,530 plans, 53.9% of the plans that list it. Other plans place it on Tier 4 (1,446 plans), Tier 2 (397 plans) or Tier 1 (324 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. 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.