OBJECTIVES: Rosacea is one of the most prevalent skin ailments in the US, with an estimated prevalence of 16 million. The objective of this analysis was to evaluate the annual costs of therapy and budget impact of topical treatments for the inflammatory papules and pustules of mild to moderate rosacea. METHODS: An economic model was developed from the managed care perspective with a 1-year time horizon. Topical treatments for rosacea included in the model were azelaic acid foam 15%, azelaic acid gel 15%, metronidazole (gel, cream, and lotion), sodium sulfacetamide/sulfur (cream, foam, and lotion), and benzoyl peroxide (foam, gel, and lotion). The expected cost of treatment for each therapy was based on the published wholesale acquisition cost (WAC) as of November 2015. The number of yearly prescriptions and product utilization by formulation was based on a retrospective database analysis using the MarketScan Commercial Claims and Encounters and Medical Care Supplemental Databases from 1/1/2010-12/31/2014.  RESULTS: The total annual pharmacy costs were lowest for benzoyl peroxide ($25), followed by metronidazole ($205), azelaic acid foam ($318), azelaic acid gel ($318), and sodium sulfacetamide/sulfur ($483). At the market introduction of azelaic acid foam, the market share breakdown was 23.3% azelaic acid gel, 72.6% metronidazole, 2.7% sodium sulfacetamide/sulfur, and 1.4% benzoyl peroxide. Assuming a 10% market uptake of azelaic acid foam in 2016, the budget impact of azelaic acid foam for a health plan with 1,000,000 members is $114,935 or $0.01 PMPM.  CONCLUSIONS: Total annual costs for topical treatments for rosacea ranged from $25 to $483 per patient. The introduction of azelaic acid 15% foam is projected to have a minimal budget impact of $0.01 PMPM for a 1,000,000-member health plan. The cost of azelaic acid foam is exactly the same as that of azelaic acid gel.