UBRELVY 50 mg Tablet
Also known as Ubrogepant. Coverage in Michigan (CMS PDP Region 13).
7 of 12 stand-alone Part D plans in Michigan cover this drug on tier 3–5.
Lowest 30-day cost $45.00 at a preferred pharmacy. 7 of 7 plans apply a prior authorization, step therapy or quantity limit.
127 Medicare Advantage plans in MI 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. MI: 127 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| Humana Basic Rx Plan (PDP)$0.00/mo premium · $615.00 deductible | 3Preferred Brand | 25% | 20% | $109.2625 | $1,748.2016 units |
|
| Humana Value Rx Plan (PDP)$0.00/mo premium · $601.00 deductible | 3Preferred Brand | 20% | 15% | $109.2625 | $1,748.2016 units |
|
| SilverScript Choice (PDP)$78.30/mo premium · $615.00 deductible | 3Preferred Brand | 18% | 18% | $114.8090 | $1,836.9416 units |
|
| Humana Premier Rx Plan (PDP)$98.10/mo premium · $0.00 deductible | 3Preferred Brand | $45.00 | $125.00 | $109.2625 | $1,748.2016 units |
|
| AARP Medicare Rx Preferred from UHC (PDP)$78.30/mo premium · $130.00 deductible | 4Non-Preferred Drug | 32% | — | $115.9227 | $1,854.7616 units |
|
| Prescription Blue Select (PDP)$78.40/mo premium · $615.00 deductible | 5Specialty Tier | 25% | — | $109.1002 | $1,745.6016 units |
|
| Prescription Blue Premium (PDP)$106.70/mo premium · $0.00 deductible | 5Specialty Tier | 33% | — | $109.1002 | $1,745.6016 units |
|
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.