UBRELVY 50 mg Tablet

Also known as Ubrogepant. Coverage in New Jersey (CMS PDP Region 04).

5 of 12 stand-alone Part D plans in New Jersey cover this drug on tier 3–4.

Lowest 30-day cost $45.00 at a preferred pharmacy. 5 of 5 plans apply a prior authorization, step therapy or quantity limit.

56 Medicare Advantage plans in NJ 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. NJ: 56 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)$4.40/mo premium · $615.00 deductible	3Preferred Brand	25%	20%	$108.8222	$1,741.1616 units	Prior authorization Quantity limit 16 per 30 days
Humana Value Rx Plan (PDP)$35.60/mo premium · $601.00 deductible	3Preferred Brand	19%	14%	$108.8222	$1,741.1616 units	Prior authorization Quantity limit 16 per 30 days
SilverScript Choice (PDP)$97.40/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$114.8205	$1,837.1316 units	Prior authorization Quantity limit 16 per 30 days
Humana Premier Rx Plan (PDP)$111.90/mo premium · $0.00 deductible	3Preferred Brand	$45.00	$125.00	$108.8222	$1,741.1616 units	Prior authorization Quantity limit 16 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$118.90/mo premium · $130.00 deductible	4Non-Preferred Drug	33%	—	$115.2659	$1,844.2516 units	Prior authorization Quantity limit 16 per 30 days

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.

See coverage in all 39 regions →