Medicare Part D coverage · fidaxomicin · RxCUI 2279847
fidaxomicin 40 MG/ML Oral Suspension [Dificid]
Per the CMS 2026 Part D formulary file, fidaxomicin 40 MG/ML Oral Suspension [Dificid] is covered by 2,425 Medicare Part D plans (48% of enrollable products), averaging Tier 4.1, with prior authorization required on 19.7% of covering formularies.
- 48%
- Plan coverage
- 2,425
- Plans covering
- T4.1
- Avg tier
- 19.7%
- Prior auth required
What the CMS Formulary Data Shows for fidaxomicin 40 MG/ML Oral Suspension [Dificid]
Per the CMS 2026 Part D formulary file, fidaxomicin 40 MG/ML Oral Suspension [Dificid] (RxNorm concept RXCUI 2279847, generic name fidaxomicin) appears on 213 distinct formulary files spanning 2,425 Medicare Part D plan offerings - 48% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 4.1.
Real-world access to fidaxomicin 40 MG/ML Oral Suspension [Dificid] depends on utilization management as much as tier placement: 19.7% of covering formularies require prior authorization. 3.8% require step therapy. 57.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 21,562 Part D beneficiaries filled fidaxomicin 40 MG/ML Oral Suspension [Dificid] in 2023, with total plan-and-beneficiary spending of $127,162,103 and an average per-beneficiary annual cost of $5,897.51. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry fidaxomicin 40 MG/ML Oral Suspension [Dificid] today.
Coverage Details
- Formularies covering
- 213
- Plans covering
- 2,425
- Coverage rate
- 48%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 19.7% of formularies
- Step therapy required
- 3.8% of formularies
- Quantity limits
- 57.3% of formularies
2023 Medicare Spending
- Beneficiaries
- 21,562
- Total spending
- $127,162,103
- Avg per beneficiary
- $5,897.51
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering fidaxomicin 40 MG/ML Oral Suspension [Dificid]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | Yes | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| PruittHealth Premier D-SNP (HMO D-SNP) | Pruitthealth Premier, Inc. | T1 | Yes | $0 | GA |
| Simpra Advantage Dual Care (PPO D-SNP) | Simpra Advantage, Inc. | T1 | Yes | $0 | AL |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
Show the next 30 plans
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| Platino Blindao (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Advance (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Platino Plus (HMO D-snp) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Senior Care (HMO I-SNP) | Align Senior Care Florida, Inc. | T1 | Yes | $4.80 | FL |
| ProCare Advantage (HMO-POS I-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| ProCare Advantage - Kidney Care (HMO-POS C-SNP) | Procare Advantage, LLC | T1 | Yes | $4.80 | TX |
| American Health Advantage of Florida (HMO I-SNP) | American Health Plan OF FL, Inc. | T1 | Yes | $4.80 | FL |
| SECUR Advantage (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is fidaxomicin 40 MG/ML Oral Suspension [Dificid] covered by Medicare Part D?
Yes, fidaxomicin 40 MG/ML Oral Suspension [Dificid] is covered by 2,425 Medicare Part D plans (48% of all Part D formularies).
What tier is fidaxomicin 40 MG/ML Oral Suspension [Dificid] on Medicare Part D plans?
fidaxomicin 40 MG/ML Oral Suspension [Dificid] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 6.
Does fidaxomicin 40 MG/ML Oral Suspension [Dificid] require prior authorization?
19.7% of Part D formularies require prior authorization for fidaxomicin 40 MG/ML Oral Suspension [Dificid]. Step therapy: 3.8%. Quantity limits: 57.3%.
How much does Medicare spend on fidaxomicin 40 MG/ML Oral Suspension [Dificid]?
In 2023, total Medicare Part D spending on fidaxomicin 40 MG/ML Oral Suspension [Dificid] was $127,162,103, covering 21,562 beneficiaries. The average spend per beneficiary was $5,897.51.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- everolimus 1 MG Oral Tablet T4.1
- iloperidone 2 MG Oral Tablet [Fanapt] T4.1
- raltegravir 100 MG Granules for Oral Suspension [Isentress] T4.1
- 24 HR tofacitinib 11 MG Extended Release Oral Tablet [Xeljanz] T4.1
- tofacitinib 5 MG Oral Tablet [Xeljanz] T4.1
- risdiplam 0.75 MG/ML Oral Solution [Evrysdi] T4.1
Similar prior-authorization rate
- glyburide 1.25 MG / metformin hydrochloride 250 MG Oral Tablet 19.7% PA
- glyburide 2.5 MG / metformin hydrochloride 500 MG Oral Tablet 19.7% PA
- patiromer 8400 MG Powder for Oral Suspension [Veltassa] 19.6% PA
- sevelamer carbonate 2400 MG Powder for Oral Suspension 19.8% PA
- patiromer 25200 MG Powder for Oral Suspension [Veltassa] 19.8% PA
- linezolid 600 MG Oral Tablet 19.8% PA