How to Help Your Patients Find Dificid in Stock: A Provider's Guide

You've made the clinical decision to prescribe Fidaxomicin for your patient's C. difficile infection. The evidence supports it, the guidelines favor it — and then your patient calls back saying their pharmacy doesn't have it in stock.

This scenario is far too common with Dificid (Fidaxomicin). Despite not being in a formal shortage, it's one of the most difficult antibiotics for patients to fill in the community setting. This guide provides a practical, step-by-step approach to help your patients get the medication they need without unnecessary delays.

Current Availability Landscape

As of 2026, Dificid faces a unique access challenge. There is no FDA-listed shortage, and manufacturing supply is adequate. The barriers are economic and logistical:

• Cost: Brand-name Dificid runs $5,100–$6,550 per course (20 tablets). Teva's generic Fidaxomicin, launched in July 2025, is more affordable at ~$1,290–$1,800 with discount coupons.
• Limited stocking: Most retail chain pharmacies (CVS, Walgreens, Rite Aid) do not routinely stock it due to the high per-unit cost and low outpatient volume.
• Prior authorization: Most payors require PA and/or step therapy, adding delays to an already time-sensitive clinical situation.

For a comprehensive overview of the supply situation, see our companion briefing: Dificid Shortage: What Providers Need to Know.

Why Patients Can't Find Dificid

Understanding the patient experience is important for efficient problem-solving:

1. Pharmacy doesn't stock it: Patient arrives at pharmacy and is told they don't carry it and can't get it quickly
2. Insurance delays: Prior authorization takes 24–72 hours; patient is symptomatic and waiting
3. Specialty pharmacy redirect: Patient's plan requires a specialty pharmacy, but neither the patient nor prescriber realized this upfront
4. Cost shock: Even with insurance, copays can be $50–$500+ depending on formulary tier. Uninsured patients face $1,290–$6,550
5. Confusion between brand and generic: Patient (or pharmacy) may not realize a generic option exists

What Providers Can Do: 5 Steps

Step 1: Prescribe Generic Fidaxomicin

Unless there's a specific clinical reason, prescribe as "Fidaxomicin 200 mg tablets" rather than brand-name Dificid. The Teva generic is AB-rated and therapeutically equivalent. It's cheaper, more likely to be in stock, and will facilitate easier pharmacy processing.

Avoid writing "DAW" (Dispense as Written) unless truly necessary — this prevents generic substitution and increases cost barriers for patients.

Step 2: Submit Prior Authorization Proactively

Don't wait for the pharmacy to reject the claim. If your patient has commercial or Medicare Part D coverage, submit PA at the time of prescribing. Key documentation to include:

• CDI diagnosis (ICD-10: A04.72 for recurrent, A04.71 for initial)
• Prior Vancomycin use or documented reason for step therapy bypass
• Clinical rationale (recurrent infection, high-risk patient, treatment failure)

Many EHR systems support electronic PA through CoverMyMeds or Surescripts. Use these tools to reduce turnaround time.

Step 3: Direct Patients to the Right Pharmacy

This is where you can save your patients the most time and frustration. Before or at the time of prescribing:

• Use Medfinder for Providers to check which pharmacies near your patient currently have Fidaxomicin in stock
• If the patient's plan requires a specialty pharmacy, identify this upfront and send the prescription accordingly
• Consider independent community pharmacies, which are more likely to special-order and tend to have faster turnaround
• If the patient was hospitalized, the hospital outpatient pharmacy may be the fastest option

Step 4: Connect Patients with Financial Assistance

Proactively provide patients with savings information:

• Merck Savings Coupon: Commercially insured patients may pay as low as $50/Rx (up to 4 fills of 20 tablets)
• Teva Copay Card: Similar $50 copay offer for generic Fidaxomicin
• Merck Patient Assistance Program: Free medication for qualifying uninsured patients (merckhelps.com)
• Discount coupons: GoodRx, SingleCare, and other platforms can reduce generic pricing to ~$1,290–$1,800

Share our patient-facing savings guide: How to Save Money on Dificid.

Step 5: Have a Backup Plan Ready

For situations where Fidaxomicin cannot be obtained in a timely manner, have an alternative order ready:

• Oral Vancomycin 125 mg QID × 10 days — first-line per guidelines, widely available, much lower cost
• Consider Bezlotoxumab (Zinplava) as adjunctive therapy for patients at high recurrence risk who end up on Vancomycin instead of Fidaxomicin
• For recurrent CDI: Discuss microbiome-based therapies (Vowst, Rebyota) as follow-up to antibiotic treatment

For a full comparison, see: Alternatives to Dificid.

Workflow Tips for Your Practice

Build a Dificid Protocol

Consider creating a standard workflow for Fidaxomicin prescriptions:

1. At time of prescribing → submit PA electronically
2. Verify patient's pharmacy type (retail vs. specialty requirement)
3. Check availability via Medfinder and direct patient to a stocking pharmacy
4. Provide savings card information or refer to financial assistance
5. Document backup order (oral Vancomycin) in case Fidaxomicin is delayed

Discharge Planning for Inpatients

For patients being discharged after CDI treatment who need outpatient Fidaxomicin:

• Initiate PA before discharge
• Fill through the hospital outpatient pharmacy if available (often fastest)
• Send patient home with a 2–3 day bridge supply of Vancomycin if Fidaxomicin may not be available same-day
• Provide printed information on Medfinder and savings programs

Staff Education

Ensure your clinical staff (nurses, care coordinators, pharmacy liaisons) understand the Dificid access landscape. A brief in-service covering the PA requirements, pharmacy stocking issues, and available savings programs can significantly reduce patient callbacks and treatment delays.

Final Thoughts

The gap between prescribing Fidaxomicin and patients actually filling it is one of the more frustrating access challenges in outpatient infectious disease care. But with a structured approach — proactive PA submission, directing patients to the right pharmacy, and connecting them with financial assistance — you can significantly reduce delays and ensure your patients get timely treatment.

Visit Medfinder for Providers to add real-time pharmacy availability checking to your workflow. For cost-saving guidance you can share with patients, see our provider's guide to helping patients save on Dificid.