CLONIDINE TRANSDERMAL SYSTEM .3 mg/d Patch
Also known as Clonidine. Coverage in Michigan (CMS PDP Region 13).
12 of 12 stand-alone Part D plans in Michigan cover this drug on tier 4.
8 of 12 plans apply a prior authorization, step therapy or quantity limit.
177 Medicare Advantage plans in MI do cover it
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D. A patient on an MA-PD plan may have coverage even where no PDP lists the drug. MI: 177 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Wellcare Classic (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 28% | 28% | $32.7099 | — | None |
| Wellcare Value Script (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 40% | 40% | $32.6871 | — | None |
| HealthSpring Assurance Rx (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 30% | 30% | $31.9258 | $127.704 units |
|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $21.3920 | $85.574 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 4Non-Preferred Drug | 33% | — | $21.5219 | $86.094 units |
|
| AARP Medicare Rx Saver from UHC (PDP)$14.10/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | — | $18.0666 | — | None |
| HealthSpring Extra Rx (PDP)$50.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | 32% | $36.3821 | $145.534 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $17.4470 | $157.029 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 4Non-Preferred Drug | 32% | — | $18.0512 | — | None |
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 25% | 25% | $30.4270 | $121.714 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $21.3190 | $85.284 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 4Non-Preferred Drug | 27% | 27% | $30.4270 | $121.714 units |
|
Cost-sharing is the initial coverage phase at a preferred pharmacy; a percentage is coinsurance of the plan’s negotiated price, and the deductible may apply first. CMS publishes a negotiated price per unit, so the 30-day fill is shown only where the plan’s own quantity limit supplies the quantity.