dalbavancin 500 MG Injection [Dalvance]
dalbavancin
RxCUI: 1539248
What the CMS Formulary Data Shows for dalbavancin 500 MG Injection [Dalvance]
Per the CMS 2026 Part D formulary file, dalbavancin 500 MG Injection [Dalvance] (RxNorm concept RXCUI 1539248, generic name dalbavancin) appears on 11 distinct formulary files spanning 226 Medicare Part D plan offerings - 4.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.2.
Real-world access to dalbavancin 500 MG Injection [Dalvance] depends on utilization management as much as tier placement: 9.1% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,299 Part D beneficiaries filled dalbavancin 500 MG Injection [Dalvance] in 2023, with total plan-and-beneficiary spending of $13,677,432 and an average per-beneficiary annual cost of $10,529.20. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry dalbavancin 500 MG Injection [Dalvance] today.
Coverage Details
- Formularies covering
- 11
- Plans covering
- 226
- Coverage rate
- 4.5%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 9.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,299
- Total spending
- $13,677,432
- Avg per beneficiary
- $10,529.20
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering dalbavancin 500 MG Injection [Dalvance]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | No | $34.50 | NY |
| CalOptima Health OneCare Complete (HMO D-SNP) | ORANGE COUNTY HEALTH AUTHORITY | T2 | Yes | $0 | CA |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | UT |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Essential (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Flex (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare + Kroger (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Active (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | CO |
| Select Health Medicare Dual (HMO D-SNP) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Select Health Medicare Wellness (HMO) | SELECTHEALTH, INC. | T4 | No | $0 | NV |
| Healthy Mississippi Premier Advantage (HMO-POS) | Healthy Mississippi, Inc. | T4 | No | $0 | MS |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF ARIZONA, INC. | T5 | No | $0 | AZ |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Heart & Diabetes (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health AllCare Preferred (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Platinum + Instacart (HMO-POS) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health My Choice (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Harmony (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Balance (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health the ONE (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health the ONE + Walgreens (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health CommUnity (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health smartSavings (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health My Choice Select (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health My Choice CalCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Honor+ Plan (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health ValorCare (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Heart & Diabetes Care (HMO C-SNP) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health L.A. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health S.D. Premium Giveback (HMO) | ALIGNMENT HEALTH PLAN | T5 | No | $0 | CA |
| Alignment Health Platinum (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | No | $0 | NC |
| Alignment Health NC Duals (HMO-POS D-SNP) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | No | $0 | NC |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | No | $0 | NC |
| Alignment Health Platinum + Instacart (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | No | $0 | NV |
| Alignment Health smartHMO (HMO) | ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC. | T5 | No | $0 | NV |
Frequently Asked Questions
Is dalbavancin 500 MG Injection [Dalvance] covered by Medicare Part D?
Yes, dalbavancin 500 MG Injection [Dalvance] is covered by 226 Medicare Part D plans (4.5% of all Part D formularies).
What tier is dalbavancin 500 MG Injection [Dalvance] on Medicare Part D plans?
dalbavancin 500 MG Injection [Dalvance] averages Tier 4.2 across Part D plans, ranging from Tier 1 to Tier 5.
Does dalbavancin 500 MG Injection [Dalvance] require prior authorization?
9.1% of Part D formularies require prior authorization for dalbavancin 500 MG Injection [Dalvance]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on dalbavancin 500 MG Injection [Dalvance]?
In 2023, total Medicare Part D spending on dalbavancin 500 MG Injection [Dalvance] was $13,677,432, covering 1,299 beneficiaries. The average spend per beneficiary was $10,529.20.
Read our methodology - how this data is sourced, computed, and verified.