24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule

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cyclobenzaprine hydrochloride

RxCUI: 828358

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.
0.1%
Plan Coverage
6
Plans Covering
T4
Avg Tier
100%
Prior Auth Required

What the CMS Formulary Data Shows for 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule

Per the CMS 2026 Part D formulary file, 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule (RxNorm concept RXCUI 828358, generic name cyclobenzaprine hydrochloride) appears on 1 distinct formulary file spanning 6 Medicare Part D plan offerings - 0.1% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 4 to Tier 4, with a cross-plan average of Tier 4.

Real-world access to 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.

Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule today.

Coverage Details

Formularies covering
1
Plans covering
6
Coverage rate
0.1%
Tier range
Tier 4, Non-Preferred
Average tier
Tier 4, Non-Preferred

Restrictions

Prior authorization required
100% of formularies
Step therapy required
0% of formularies
Quantity limits
0% of formularies

Tier Distribution Across Plans

6 plans
Tier 4, Non-Preferred

Medicare Advantage Plans (MA-PD) Covering 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule

6 Medicare Advantage plans with Part D drug coverage include this drug.

Plan Insurer Tier PA Premium States
Keystone 65 Select Rx (HMO) KEYSTONE HEALTH PLAN EAST, INC. T4 Yes $47.00 PA
Keystone 65 Preferred Rx (HMO) KEYSTONE HEALTH PLAN EAST, INC. T4 Yes $59.70 PA
Keystone 65 Select Rx (HMO) KEYSTONE HEALTH PLAN EAST, INC. T4 Yes $63.50 PA
Keystone 65 Preferred Rx (HMO) KEYSTONE HEALTH PLAN EAST, INC. T4 Yes $79.70 PA
Personal Choice 65 Rx (PPO) QCC INSURANCE COMPANY T4 Yes $102.20 PA
Personal Choice 65 Rx (PPO) QCC INSURANCE COMPANY T4 Yes $112.70 PA

Frequently Asked Questions

Is 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule covered by Medicare Part D?

Yes, 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule is covered by 6 Medicare Part D plans (0.1% of all Part D formularies).

What tier is 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule on Medicare Part D plans?

24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule averages Tier 4 across Part D plans, ranging from Tier 4 to Tier 4.

Does 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule require prior authorization?

100% of Part D formularies require prior authorization for 24 HR cyclobenzaprine hydrochloride 15 MG Extended Release Oral Capsule. Step therapy: 0%. Quantity limits: 0%.

Read our methodology - how this data is sourced, computed, and verified.

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare Editorial