Limited coverage drugs – tizanidine

Last updated on September 27, 2024

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Generic name	tizanidine
Strength	4 mg
Form	tablet

Criteria	Approval period
Diagnosis of spasticity PLUS documented evidence of treatment failure on or intolerance to diazepam or baclofen.	Indefinite

Practitioner exemptions

None

Special notes

None

Special Authority requests

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HLTH 5328 Special Authority request form (PDF, 523KB)

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Limited coverage drugs – tizanidine

Practitioner exemptions

Special notes

Special Authority requests