TIZANIDINE HYDROCHLORIDE 4 mg Capsule
Coverage in Maine and New Hampshire (CMS PDP Region 01).
1 of 9 stand-alone Part D plans in Maine and New Hampshire cover this drug on tier 4.
No plan applies a prior authorization, step therapy or quantity limit.
7 Medicare Advantage plans in ME, NH 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. ME: 6 plans · NH: 1 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$94.90/mo premium · $615.00 deductible | 4Non-Preferred Drug | 33% | 33% | $1.0445 | — | None |
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.