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Home › Medications › Dalfampridine extended-release (Ampyra and others) › Tier 3 plans

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Dalfampridine extended-release (Ampyra and others) — plans on this site that list it on Tier 3

2212 plans published on this site list this drug on Tier 3, grouped by company. Plans are sold by county — the service area under each plan shows where it is offered.

AMH Health

5 plans on this site

Aetna Medicare

121 plans on this site

Align powered by Sanford Health Plan

2 plans on this site

Alignment Health Plan

72 plans on this site

Allina Health Aetna Medicare

7 plans on this site

AlohaCare

1 plan on this site

AmeriHealth

2 plans on this site

AmeriHealth Caritas VIP Care (HMO-D-SNP)

1 plan on this site

Anthem Blue Cross

7 plans on this site

Anthem Blue Cross Partnership Plan

5 plans on this site

Anthem Blue Cross and Blue Shield

24 plans on this site

Anthem Blue Cross and Blue Shield HP

2 plans on this site

Anthem HealthKeepers

6 plans on this site

Arkansas Blue Medicare

3 plans on this site

Astiva Health

8 plans on this site

Banner Medicare Advantage

1 plan on this site

Baylor Scott & White Health Plan

6 plans on this site

Blue Care Network

4 plans on this site

Blue Cross & Blue Shield of Rhode Island

5 plans on this site

Blue Cross Blue Shield of Arizona (AZ Blue)

3 plans on this site

Blue Cross Blue Shield of Michigan

8 plans on this site

Blue Cross Blue Shield of South Carolina

2 plans on this site

Blue Cross and Blue Shield of Alabama

3 plans on this site

Blue Cross and Blue Shield of IL, NM

4 plans on this site

Blue Cross and Blue Shield of Kansas

3 plans on this site

Blue Cross and Blue Shield of Louisiana

8 plans on this site

Blue Cross and Blue Shield of Minnesota

3 plans on this site

Blue Cross and Blue Shield of Nebraska

3 plans on this site

Blue Cross and Blue Shield of North Carolina

5 plans on this site

Blue Cross of Idaho

6 plans on this site

Blue Plus

1 plan on this site

Blue Shield of California

9 plans on this site

CDPHP Medicare Advantage

3 plans on this site

  • CDPHP $0 Medicare Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
  • CDPHP Choice Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington
  • CDPHP Clear Rx (HMO) — Offered in NY: Albany, Columbia, Greene, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, Washington

Capital Blue Cross

10 plans on this site

Capital Health Plan

4 plans on this site

CareFirst BlueCross BlueShield Advantage DualPrime

1 plan on this site

CareFirst BlueCross BlueShield Medicare Advantage

3 plans on this site

Clover Health

8 plans on this site

Community Health Plan of WA Medicare Advantage

2 plans on this site

Dean Advantage

4 plans on this site

Devoted Health

687 plans on this site

Doctors HealthCare Plans, Inc.

9 plans on this site

Elderplan

1 plan on this site

EmblemHealth

5 plans on this site

Essence Healthcare

7 plans on this site

Excellus Health Plan Community Care LLC

4 plans on this site

Excellus Health Plan, Inc

14 plans on this site

Fallon Health

3 plans on this site

First Choice VIP Care (HMO D-SNP)

1 plan on this site

Florida Blue

2 plans on this site

Florida Blue HMO

6 plans on this site

Florida Complete Care

3 plans on this site

Gold Coast Health Plan

1 plan on this site

Great Plains Medicare Advantage

3 plans on this site

Group Health Cooperative of Eau Claire

2 plans on this site

HAP CareSource MI Coordinated Health

1 plan on this site

HMSA Akamai Advantage

5 plans on this site

Health First Health Plans, Inc.

6 plans on this site

Health New England Medicare Advantage Plans

6 plans on this site

HealthPartners

5 plans on this site

HealthSpring

15 plans on this site

HealthSun Health Plans, Inc.

6 plans on this site

HealthTeam Advantage

4 plans on this site

Healthfirst Medicare Plan

6 plans on this site

Healthy Arkansas, Inc.

3 plans on this site

Healthy Blue

3 plans on this site

Healthy Mississippi, Inc.

4 plans on this site

Highmark Blue Cross Blue Shield

4 plans on this site

Highmark Blue Cross Blue Shield or Highmark Blue Shield

20 plans on this site

Highmark Wholecare Medicare Assured

2 plans on this site

Horizon Blue Cross Blue Shield of New Jersey

1 plan on this site

Imperial Health Plan of California, Inc.

3 plans on this site

Independence Blue Cross

8 plans on this site

Independent Health

6 plans on this site

Itasca Medical Care/IMCare Classic

1 plan on this site

Jefferson Health Plans

10 plans on this site

Johns Hopkins Advantage MD

2 plans on this site

KelseyCare Advantage

2 plans on this site

MCS Classicare

16 plans on this site

MVP HEALTH CARE

7 plans on this site

Martin's Point Generations Advantage

2 plans on this site

Mass General Brigham Health Plan

3 plans on this site

MediGold

8 plans on this site

Medica

6 plans on this site

Medical Mutual of Ohio

10 plans on this site

MetroPlus Health Plan

1 plan on this site

Molina Healthcare of Illinois

1 plan on this site

Molina Healthcare of Massachusetts

3 plans on this site

Molina Healthcare of Michigan

1 plan on this site

Molina Healthcare of Ohio

2 plans on this site

Molina Healthcare of Texas, Inc.

1 plan on this site

Molina Healthcare of Washington, Inc.

1 plan on this site

Molina Healthcare of Wisconsin

2 plans on this site

MyAdvocate Medicare Advantage

2 plans on this site

Neighborhood Health Plan of Rhode Island

2 plans on this site

Network Health Medicare Advantage Plans

7 plans on this site

PacificSource Medicare

5 plans on this site

Passport Advantage

1 plan on this site

Peoples Health

11 plans on this site

PrimeTime Health Plan

3 plans on this site

Priority Health Medicare

12 plans on this site

Quartz Medicare Advantage (HMO)

14 plans on this site

Range Health

4 plans on this site

Regence BlueCross BlueShield of Oregon

3 plans on this site

Regence BlueShield

1 plan on this site

SCAN Health Plan

32 plans on this site

Samaritan Advantage Health Plans

1 plan on this site

Security Health Plan of Wisconsin, Inc.

4 plans on this site

Select Health

4 plans on this site

Senior Whole Health of New York

2 plans on this site

Simply Healthcare Plans, Inc.

2 plans on this site

Solis Health Plans

5 plans on this site

South Country Health Alliance

2 plans on this site

St. Luke's Health Plan

3 plans on this site

The Health Plan

4 plans on this site

Trinity Health Plan New York

2 plans on this site

Trinity Health Plan of Michigan

3 plans on this site

Tufts Health Plan

6 plans on this site

UPMC for Life

11 plans on this site

UPMC for Life Complete Care

1 plan on this site

Ultimate Health Plans

5 plans on this site

UnitedHealthcare

696 plans on this site

Upper Peninsula Health Plan (UPHP) MI Coordinated Health

1 plan on this site

VISTA Health Plan Inc.

2 plans on this site

VIVA Medicare

5 plans on this site

VillageHealth

2 plans on this site

Wellpoint

30 plans on this site

WyoBlue Advantage

2 plans on this site

Zing Health

6 plans on this site

eternalHealth

6 plans on this site

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage.

Source: CMS Prescription Drug Plan Formulary data + this site's published plan records · List built 2026-11-08

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