Almirall announced expanded formulary access for tirbanibulin through CVS Caremark at the end of March. On its face, it’s a coverage update. In practice, it may change how often this is a realistic option in clinic. 

KLISYRI (tirbanibulin) has been added to multiple CVS Caremark commercial formularies, including Standard Control, Advanced Control, and Performance Standard. The expansion places tirbanibulin under coverage for an estimated 26 million commercially insured patients in the U.S. 

Coverage still follows a familiar structure: 

• Prior authorization aligned with label
• Step-through of at least one prior topical field therapy 

So this isn’t a removal of barriers, but it may reduce how often access stops the conversation early. 

Where this shows up in practice 

Actinic keratosis treatment decisions sit somewhere between clearance, tolerability, and what a patient is willing to manage, especially on visible areas like the face and scalp. 

Tirbanibulin has been part of that mix, in part because of its short course and localized mechanism as a microtubule inhibitor. Access, though, has been less consistent. 

That inconsistency shape decisions—reaching for what is more likely to be approved, avoiding delays when the clinic day is already full, defaulting to familiar pathways. Formulary inclusion doesn’t change the clinical calculus. It just makes the option more usable. 

The operational layer still matters 

This update still comes with step edits, prior authorization, and documentation requirements. The difference will likely come down to execution: 

• How clearly prior therapy is documented
• Whether EHR workflows support the submission
• How often staff have to troubleshoot the same request 

For most practices, that’s where access either works or doesn’t. These updates move quickly from announcement to anecdote and usually settle into a pattern within a few months. 

This is a small adjustment in what’s available—and how reliably. For some patients, it will be the difference between an option on paper and one that actually makes it through. In practice, that’s often enough to change what gets used.

For more information, see the full press release.