ELETRIPTAN HYDROBROMIDE 20 mg Tablet, Film Coated
Coverage in Connecticut, Massachusetts, Rhode Island and Vermont (CMS PDP Region 02).
4 of 11 stand-alone Part D plans in Connecticut, Massachusetts, Rhode Island and Vermont cover this drug on tier 2–4.
Lowest 30-day cost $10.00 at a preferred pharmacy. 4 of 4 plans apply a prior authorization, step therapy or quantity limit.
36 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: 11 plans · MA: 20 plans · RI: 3 plans · VT: 2 plans.
Every plan that covers it
| Plan | Tier | 30-day preferred | 90-day mail | Unit cost | Est. 30-day fill | Restrictions |
|---|---|---|---|---|---|---|
| SilverScript Choice (PDP)$32.70/mo premium · $615.00 deductible | 2Generic | $10.00 | $30.00 | $1.4505 | $17.4112 units |
|
| Humana Basic Rx Plan (PDP)$8.40/mo premium · $615.00 deductible | 4Non-Preferred Drug | 32% | — | $4.2608 | $38.359 units |
|
| Humana Value Rx Plan (PDP)$73.60/mo premium · $601.00 deductible | 4Non-Preferred Drug | 31% | — | $4.2763 | $38.499 units |
|
| Humana Premier Rx Plan (PDP)$138.60/mo premium · $0.00 deductible | 4Non-Preferred Drug | 50% | 50% | $4.2520 | $38.279 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.