UBRELVY 100 mg Tablet

Also known as Ubrogepant. Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).

7 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 3–4.

Lowest 30-day cost $30.00 at a preferred pharmacy. 7 of 7 plans apply a prior authorization, step therapy or quantity limit.

135 Medicare Advantage plans in CT, MA, RI, VT 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. CT: 34 plans · MA: 84 plans · RI: 15 plans · VT: 2 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)$8.40/mo premium · $615.00 deductible	3Preferred Brand	25%	20%	$109.5805	$1,753.2916 units	Prior authorization Quantity limit 16 per 30 days
Blue MedicareRx Value Plus (PDP)$20.70/mo premium · $615.00 deductible	3Preferred Brand	17%	17%	$108.7297	$1,739.6816 units	Prior authorization Quantity limit 16 per 30 days
SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible	3Preferred Brand	19%	19%	$114.8117	$1,836.9916 units	Prior authorization Quantity limit 16 per 30 days
Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible	3Preferred Brand	18%	13%	$109.5805	$1,753.2916 units	Prior authorization Quantity limit 16 per 30 days
Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible	3Preferred Brand	$45.00	$125.00	$109.5805	$1,753.2916 units	Prior authorization Quantity limit 16 per 30 days
Blue MedicareRx Premier (PDP)$238.60/mo premium · $0.00 deductible	3Preferred Brand	$30.00	$60.00	$108.7297	$1,739.6816 units	Prior authorization Quantity limit 16 per 30 days
AARP Medicare Rx Preferred from UHC (PDP)$155.10/mo premium · $130.00 deductible	4Non-Preferred Drug	30%	—	$115.8781	$1,854.0516 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 →