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Workers’ Compensation Medicare Set-Aside (WCMSA) price of tizanidine 4 mg tablets increases 1,522%

October 28, 2020 · Optum Workers' Comp and Auto No-fault

The RED BOOK® September 2020 update indicated Major Pharmaceuticals recently discontinued their formulation of tizanidine 4 mg tablets. As a result, the October 2020 update to the Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) shows pricing of tizanidine 4 mg tablets increased from $0.09 per tablet (the Average Wholesale Price, or AWP, of the discontinued Major Pharmaceuticals product) to $1.46 per tablet, now the lowest available non-repackaged AWP. This increase means a 1,522% price surge for tizanidine 4 mg tablets allocated in WCMSAs and returns the WCMSAP price of this medication to where it was prior to August 2019, when the cost dropped significantly due to the low pricing available through Major Pharmaceuticals.

Tizanidine is a skeletal muscle relaxant commonly prescribed to injured workers to alleviate muscle spasms.

Drug Name Strength and
Drug class Prior AWP*    New AWP*  
Tizanidine 4 mg tablets Skeletal muscle relaxant $0.09/tablet $1.46/tablet




*Pricing from WCMSAP

Recommended actions to take
Optum recommends that carriers, TPAs and claim handlers review cases where tizanidine has been prescribed to determine the increase in cost of WCMSAs due to this change. Optum can assist clients who are interested in exploring potential clinical mitigation options relative to the price increase of tizanidine.

Implications of tizanidine use
While tizanidine is a preferred muscle relaxant agent in many cases, long-term use is not recommended, and chronic use can potentially be addressed with prescribers. We advise claim handlers to review open cases to assess the prescribed medication regimen to determine if clinical mitigation efforts would be beneficial as the increased cost of tizanidine alone may not be an impediment to settlement.

Ongoing Best Practices
We continually monitor the RED BOOK AWP for changes to common medications in WCMSAs, as well as new generic medications. As an established Medicare Secondary Payer (MSP) compliance services provider, our goal is to keep clients and the property and casualty insurance industry informed of changes affecting MSP compliance and WCMSAs.



  1. RED BOOK - (Subscription required)
  2. WCMSA Portal -

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