UBRELVY 50 mg Tablet

Also known as Ubrogepant. Coverage in South Carolina (CMS PDP Region 09).

6 of 11 stand-alone Part D plans in South Carolina cover this drug on tier 3–5.

Lowest 30-day cost $45.00 at a preferred pharmacy. 6 of 6 plans apply a prior authorization, step therapy or quantity limit.

63 Medicare Advantage plans in SC 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. SC: 63 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)$10.10/mo premium · $615.00 deductible	3Preferred Brand	25%	20%	$109.4048	$1,750.4816 units	Prior authorization Quantity limit 16 per 30 days
Humana Value Rx Plan (PDP)$65.60/mo premium · $601.00 deductible	3Preferred Brand	19%	14%	$109.4048	$1,750.4816 units	Prior authorization Quantity limit 16 per 30 days
SilverScript Choice (PDP)$98.40/mo premium · $615.00 deductible	3Preferred Brand	18%	18%	$114.8249	$1,837.2016 units	Prior authorization Quantity limit 16 per 30 days
Humana Premier Rx Plan (PDP)$145.60/mo premium · $0.00 deductible	3Preferred Brand	$45.00	$125.00	$109.4048	$1,750.4816 units	Prior authorization Quantity limit 16 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$139.20/mo premium · $130.00 deductible	4Non-Preferred Drug	35%	—	$115.3266	$1,845.2316 units	Prior authorization Quantity limit 16 per 30 days
BlueCross Rx Value (PDP)$139.70/mo premium · $615.00 deductible	5Specialty Tier	25%	—	$109.7033	$1,755.2516 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 →