Fluphenazine hydrochloride (tablets, oral solution, injection)

How Medicare covers it

Part D (tablets and oral solutions used at home; the formulary file also carries the short-acting hydrochloride injection concept, carried exactly in this package's aggregation). Part A during a covered inpatient or hospice stay. No Part B basis is claimed for the hydrochloride forms: the CMS Part B file's only fluphenazine row, J2680, is fluphenazine decanoate (a different salt and a separate dashboard generic), and is explicitly NOT matched.

What it treats

Fluphenazine hydrochloride tablets treat the signs of psychotic disorders, including schizophrenia. The label says it has not been shown to help with behavior problems in people with intellectual disability, which the label calls mental retardation.

What it is for, in depth

Fluphenazine hydrochloride is a phenothiazine antipsychotic prescribed for people with psychotic disorders, to manage the manifestations of those disorders, and the description section says it is intended for the management of schizophrenia. It is a continuing treatment medicine: the label advises starting low, raising the dose only until the desired effect is reached, and then slowly lowering to the smallest daily maintenance dose that keeps symptoms controlled, because the best dose varies a lot from person to person. The label states it has not been shown effective for behavioral complications in patients with mental retardation. The tablets in this label come in 1 mg, 2.5 mg, 5 mg, and 10 mg strengths for oral use. The long-acting fluphenazine decanoate injection mentioned in the label for some stabilized patients is a different product and is not the form covered by this package.

How it works

The label says fluphenazine hydrochloride acts at all levels of the central nervous system and on many organ systems. The label also says plainly that the exact way it produces its helpful effect is unknown.

How it is taken

This package is for fluphenazine hydrochloride tablets taken by mouth. The label describes film-coated tablets that are swallowed, with the daily dose often split and given at intervals during the day, and later lowered to a daily maintenance dose when symptoms are controlled. This package does not cover the separate long-acting fluphenazine decanoate injection.

Common side effects

The side effects reported most often with this family of medicines are movement effects, including muscle stiffness like Parkinson's disease, sudden muscle spasms, jerky movements, restlessness, eye-rolling episodes, arching of the body, and overactive reflexes. Other effects listed in the label include drowsiness or tiredness, nausea and loss of appetite, extra saliva, extra urination, sweating, dry mouth, headache, constipation, blurred vision, weight change, swelling, abnormal milk production, breast growth in men, menstrual changes, and skin reactions such as itching, redness, rash, sun sensitivity, and eczema.

Serious warnings

Serious risks in the label include tardive dyskinesia, a condition with involuntary movements of the tongue, face, mouth, lips, jaw, trunk, or arms and legs that may not go away, and neuroleptic malignant syndrome, a dangerous reaction with fever and muscle problems that has been reported with this kind of therapy. The label also warns about blood problems, including low white cells and other blood dyscrasias, liver damage shown as yellowing jaundice, blood pressure rises and swings, and rare sudden unexplained deaths reported in hospitalized psychotic patients taking phenothiazines. Movement reactions can be alarming and may need antiparkinson medicines or a lower dose.

Boxed warning

Boxed warning: Older adults with dementia-related psychosis who are treated with antipsychotic drugs have a higher risk of death. In the studies described in the label, most deaths were from heart problems such as heart failure or sudden death, or from infections such as pneumonia. Observational studies suggest conventional antipsychotic drugs like this one may also raise the risk of death. Fluphenazine hydrochloride is not approved to treat patients with dementia-related psychosis.

Who should be careful

People must not use this drug if they have suspected or proven damage below the cortex of the brain, a blood dyscrasia, liver damage, or an allergy to fluphenazine, and it must not be used in people who are in a coma or severely depressed states. Extra care and close watching are needed for people with a growth called pheochromocytoma, blood vessel disease in the brain, kidney failure, or weak heart reserve such as mitral insufficiency, because they are more prone to dangerous drops in blood pressure. The label gives a lower suggested starting dose for older (geriatric) patients.

Major interactions

The label extract provided does not include a drug interactions section, so it does not list specific interacting drugs. It does say the tablets must not be used by people receiving large doses of hypnotics, which are strong sleep-causing medicines, and it warns that epinephrine should not be used to treat severe low blood pressure from this drug because phenothiazines can reverse its action and lower blood pressure further.

Cost and saving notes

Fluphenazine hydrochloride tablets are a generic medicine. If your Medicare Part D plan places this drug on a tier that costs you more, you or your doctor can ask the plan for a tier exception to request a lower cost tier when that is medically appropriate. If you have limited income, Extra Help through Medicare can help pay Part D premiums and drug costs, and it is worth checking whether you qualify.

Why it is in its tier

Fluphenazine hydrochloride (tablets, oral solution, injection) sits on Tier 4 in 48.64% of the plans that list it (2673 of 5495 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 $1,103 per beneficiary for 2024 — a mid-cost drug, which matches where plans place it. It is listed by 100.0% of Part D plans. The tier shown is the most common one; individual plans vary.

Sources

• FLUPHENAZINE HYDROCHLORIDE (FLUPHENAZINE HYDROCHLORIDE) TABLET, FILM COATED [REMEDYREPACK INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Fluphenazine: MedlinePlus Drug Information

What official patient guides say

MedlinePlus says this drug must be taken regularly for a few weeks before its full effect is felt, and you should keep taking it even if you feel well and not stop without talking to your doctor. If you miss a dose, take it as soon as you remember, but if it is almost time for the next dose, skip the missed dose and do not take a double dose. Store it in its container, tightly closed, at room temperature and away from excess heat and moisture, not in the bathroom.

Source: MedlinePlus — Fluphenazine: MedlinePlus Drug Information

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 $0.2371 per unit (FLUPHENAZINE 1 MG TABLET) — about $7.11 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, 5,495 list Fluphenazine hydrochloride (tablets, oral solution, injection) — 100% of plans. Most of those plans put it on Tier 4: 2,673 plans, 48.6% of the plans that list it. Other plans place it on Tier 2 (2,042 plans), Tier 1 (402 plans) or Tier 3 (378 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 2; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 2; Aetna Medicare Value Plus (PPO) 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.