Medicare Part D coverage · fidaxomicin · RxCUI 1111110
fidaxomicin 200 MG Oral Tablet [Dificid]
Per the CMS 2026 Part D formulary file, fidaxomicin 200 MG Oral Tablet [Dificid] is covered by 3,692 Medicare Part D plans (73.1% of enrollable products), averaging Tier 4.1, with prior authorization required on 23.8% of covering formularies.
- 73.1%
- Plan coverage
- 3,692
- Plans covering
- T4.1
- Avg tier
- 23.8%
- Prior auth required
What the CMS Formulary Data Shows for fidaxomicin 200 MG Oral Tablet [Dificid]
Per the CMS 2026 Part D formulary file, fidaxomicin 200 MG Oral Tablet [Dificid] (RxNorm concept RXCUI 1111110, generic name fidaxomicin) appears on 164 distinct formulary files spanning 3,692 Medicare Part D plan offerings - 73.1% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 4.1.
Real-world access to fidaxomicin 200 MG Oral Tablet [Dificid] depends on utilization management as much as tier placement: 23.8% of covering formularies require prior authorization. 2.4% require step therapy. 68.3% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 21,562 Part D beneficiaries filled fidaxomicin 200 MG Oral Tablet [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 200 MG Oral Tablet [Dificid] today.
Coverage Details
- Formularies covering
- 164
- Plans covering
- 3,692
- Coverage rate
- 73.1%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 4, Non-Preferred
Restrictions
- Prior authorization required
- 23.8% of formularies
- Step therapy required
- 2.4% of formularies
- Quantity limits
- 68.3% 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 200 MG Oral Tablet [Dificid]
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| 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 |
| 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 |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| 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 |
Show the next 30 plans
| 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 |
| 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 |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan 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 |
| SECUR Enhanced (HMO I-SNP) | Secur Inc | T1 | Yes | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | No | $4.80 | TX |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | No | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Senior Care (HMO I-SNP) | Align Senior Care MI, LLC | T1 | Yes | $8.80 | MI |
| AgeRight Advantage Health Plan (HMO I-SNP) | Marquis Advantage, Inc. | T1 | Yes | $10.50 | OR, WA |
| Senior Care (HMO I-SNP) | Align Senior Care California Inc. | T1 | Yes | $12.00 | CA |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $13.10 | PA |
| Liberty Medicare Dual Plan (HMO D-SNP) | Liberty Advantage, LLC | T1 | Yes | $14.70 | NC |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $17.60 | PA |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is fidaxomicin 200 MG Oral Tablet [Dificid] covered by Medicare Part D?
Yes, fidaxomicin 200 MG Oral Tablet [Dificid] is covered by 3,692 Medicare Part D plans (73.1% of all Part D formularies).
What tier is fidaxomicin 200 MG Oral Tablet [Dificid] on Medicare Part D plans?
fidaxomicin 200 MG Oral Tablet [Dificid] averages Tier 4.1 across Part D plans, ranging from Tier 1 to Tier 5.
Does fidaxomicin 200 MG Oral Tablet [Dificid] require prior authorization?
23.8% of Part D formularies require prior authorization for fidaxomicin 200 MG Oral Tablet [Dificid]. Step therapy: 2.4%. Quantity limits: 68.3%.
How much does Medicare spend on fidaxomicin 200 MG Oral Tablet [Dificid]?
In 2023, total Medicare Part D spending on fidaxomicin 200 MG Oral Tablet [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
- amitriptyline hydrochloride 10 MG / perphenazine 4 MG Oral Tablet 23.8% PA
- estazolam 1 MG Oral Tablet 23.5% PA
- temazepam 22.5 MG Oral Capsule 24.1% PA
- cariprazine 1.5 MG Oral Capsule [Vraylar] 23.5% PA
- amitriptyline hydrochloride 10 MG / perphenazine 2 MG Oral Tablet 23.4% PA
- nifedipine 10 MG Oral Capsule 23.3% PA