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Dalfampridine is a generic drug. What agents check before quoting it: how many 2027 Part D plans cover it, on which tier, with what restrictions and copays, by plan type, carrier and state.
In 2027, 4,608 of 5,492 Medicare Part D and Medicare Advantage drug plans (83.9%) list Dalfampridine on their formulary, across 279 of 286 formularies. The most common placement is tier 3 (3,697 plans, 80.2% of those covering it). 3,438 of the covering plans require prior authorization (74.6%), 0 step therapy and 3,715 a quantity limit.
1,030 covering plans charge a flat copay for a 30-day supply at a preferred retail pharmacy after the deductible — median $5, 483 of them $0; 3,578 charge coinsurance instead — median 22% of the drug's cost. Once a member's out-of-pocket drug spending reaches $2,400 in 2027, covered drugs cost $0 for the rest of the year.
2026: 4,598 of 5,496 plans covered it (83.7%); 2027: 4,608 of 5,492 (83.9%).
Of 4,367 plans offered in both years, 0 added it to the formulary and 0 dropped it.
Among plans covering it both years, 80 moved it to a higher tier and 391 to a lower one; 1 added prior authorization and 13 removed it.
| Tier | Plans |
|---|---|
| Tier 1 | 389 |
| Tier 2 | 498 |
| Tier 3 | 3,697 |
| Tier 4 | 24 |
| Plan type | Plans covering | Share | Prior auth |
|---|---|---|---|
| Stand-alone Part D (PDP) | 221 of 323 | 68.4% | 67% |
| Medicare Advantage with drugs (MA-PD) | 2,658 of 3,200 | 83.1% | 78% |
| Special needs plans (SNP) | 1,729 of 1,969 | 87.8% | 70.4% |
| Carrier | Plans covering | Usual tier | Prior auth |
|---|---|---|---|
| Humana | 0 of 846 | No tier listed | 0 |
| UnitedHealthcare | 830 of 830 | Tier 3 | 0 |
| Devoted Health | 728 of 728 | Tier 3 | 728 |
| Aetna Medicare | 631 of 631 | Tier 3 | 631 |
| Wellcare | 268 of 268 | Tier 1 | 268 |
| HealthSpring | 226 of 226 | Tier 3 | 226 |
| Kaiser Permanente | 112 of 112 | Tier 2 | 16 |
| SCAN Health Plan | 83 of 83 | Tier 3 | 83 |
| Highmark Blue Cross Blue Shield or Highmark Blue Shield | 80 of 80 | Tier 3 | 80 |
| Alignment Health Plan | 77 of 77 | Tier 3 | 77 |
| Anthem Blue Cross and Blue Shield | 74 of 74 | Tier 3 | 74 |
| Wellpoint | 63 of 63 | Tier 3 | 63 |
| Priority Health Medicare | 40 of 40 | Tier 3 | 40 |
| CarePlus Health Plans, Inc. | 0 of 37 | No tier listed | 0 |
| Zing Health | 36 of 36 | Tier 2 | 36 |
| Capital Blue Cross | 35 of 35 | Tier 3 | 35 |
| Prominence Health Plan | 29 of 29 | Tier 2 | 29 |
| Medica | 27 of 27 | Tier 3 | 27 |
| Anthem HealthKeepers | 26 of 26 | Tier 3 | 26 |
| Blue Cross Blue Shield of Michigan | 26 of 26 | Tier 3 | 26 |
| State | Plans covering | Share |
|---|---|---|
| Alabama | 95 of 114 | 83.3% |
| Alaska | 6 of 9 | 66.7% |
| American Samoa | 1 of 1 | 100% |
| Arizona | 125 of 147 | 85% |
| Arkansas | 64 of 85 | 75.3% |
| California | 367 of 397 | 92.4% |
| Colorado | 87 of 106 | 82.1% |
| Connecticut | 47 of 54 | 87% |
| Delaware | 36 of 43 | 83.7% |
| District of Columbia | 11 of 12 | 91.7% |
| Florida | 430 of 545 | 78.9% |
| Georgia | 114 of 149 | 76.5% |
| Guam | 1 of 1 | 100% |
| Hawaii | 42 of 50 | 84% |
| Idaho | 34 of 45 | 75.6% |
| Illinois | 104 of 132 | 78.8% |
| Indiana | 108 of 138 | 78.3% |
| Iowa | 55 of 64 | 85.9% |
| Kansas | 65 of 84 | 77.4% |
| Kentucky | 79 of 121 | 65.3% |
| Louisiana | 89 of 125 | 71.2% |
| Maine | 37 of 52 | 71.2% |
| Maryland | 42 of 49 | 85.7% |
| Massachusetts | 82 of 89 | 92.1% |
| Michigan | 165 of 182 | 90.7% |
| Minnesota | 60 of 63 | 95.2% |
| Mississippi | 80 of 104 | 76.9% |
| Missouri | 136 of 170 | 80% |
| Montana | 10 of 27 | 37% |
| Nebraska | 43 of 51 | 84.3% |
| Nevada | 81 of 100 | 81% |
| New Hampshire | 16 of 25 | 64% |
| New Jersey | 61 of 73 | 83.6% |
| New Mexico | 54 of 68 | 79.4% |
| New York | 205 of 215 | 95.3% |
| North Carolina | 147 of 176 | 83.5% |
| North Dakota | 23 of 26 | 88.5% |
| Northern Mariana Islands | 1 of 1 | 100% |
| Ohio | 149 of 171 | 87.1% |
| Oklahoma | 58 of 81 | 71.6% |
| Oregon | 79 of 92 | 85.9% |
| Pennsylvania | 296 of 323 | 91.6% |
| Puerto Rico | 64 of 64 | 100% |
| Rhode Island | 26 of 29 | 89.7% |
| South Carolina | 66 of 89 | 74.2% |
| South Dakota | 27 of 30 | 90% |
| Tennessee | 135 of 156 | 86.5% |
| Texas | 338 of 407 | 83% |
| U.S. Virgin Islands | 1 of 1 | 100% |
| Utah | 38 of 53 | 71.7% |
| Vermont | 7 of 14 | 50% |
| Virginia | 100 of 144 | 69.4% |
| Washington | 95 of 114 | 83.3% |
| West Virginia | 52 of 69 | 75.4% |
| Wisconsin | 77 of 96 | 80.2% |
| Wyoming | 8 of 13 | 61.5% |
Medicare Part D paid for 151,426 30-day fills of Dalfampridine in 2024 for about 17,196 enrollees, at an average total cost of $330.82 per 30-day fill (CMS Part D Prescribers by Geography and Drug, national).
Price Dalfampridine and the rest of a client's list on every plan in their county.
Estimate Dalfampridine costs by plan
Free tools for licensed insurance agents. Data from CMS public files; verify with plan documents before advising a client.
Counts are over every Medicare Advantage drug plan and stand-alone Part D plan in the CMS monthly formulary files, excluding employer plans. A plan counts as covering a drug when any strength or form of it is on the plan’s formulary; the tier, prior authorization, step therapy and quantity limit shown are the most favorable version on that formulary. Copays are for a 30-day supply at a preferred retail pharmacy after the deductible. This is a reference for licensed agents, not a plan recommendation; verify with the plan’s formulary before advising a client. Source: CMS Part D formulary files (release 10/08/2026). CMS formulary data.