Medicare Ubrelvy Coverage: What You Need to Know

Let’s cut to the chase: if you’re on Medicare and wondering whether your migraine medication, Ubrelvy (ubrogepant), will be covered, the short answer is “yes—if your plan includes prescription drug coverage.” But the details matter, and they can feel a bit like trying to read a medical‑jargon novel. I’m here to break it down in plain English, sprinkle in a few real‑life stories, and help you feel confident about the next steps.

In the next few minutes we’ll explore who’s eligible, how to check your formulary, what the Medicare cost phases mean for your wallet, and where you can find extra help. Think of this as a friendly coffee chat where we’ll sort through the paperwork together, so you can get the relief you deserve without any nasty surprise bills.

Eligibility Basics

First things first—who can actually get Ubrelvy covered under Medicare?

What Medicare plans cover prescription drugs?

Medicare itself is split into parts. Part A handles hospital stays, Part B covers outpatient services, and Part D is the prescription‑drug side of the equation. If you’ve signed up for a standalone Part D plan or a Medicare Advantage plan (Part C) that bundles drug benefits, you’re in the right lane.

Can Medicare Advantage (Part C) plans include Ubrelvy?

Absolutely. Many Advantage plans bundle medical and pharmacy coverage, which means a single premium can give you both doctor visits and drug benefits. However, not every Advantage plan offers a drug benefit, so double‑check your plan’s details. The good news? According to a recent Healthline analysis, about 81 % of Medicare Part D plans already list Ubrelvy on their formularies.

Does a Medicare Part D plan automatically cover Ubrelvy?

Not automatically. Coverage depends on whether the drug appears on the plan’s formulary (its official drug list) and on which tier the drug is placed. Higher‑tier drugs, like Ubrelvy, often have higher copays, but they’re still covered as long as they’re listed.

Check Your Formulary

Now that you know you’re potentially covered, how do you confirm Ubrelvy actually appears in your plan’s drug list?

Where to find your plan’s drug list

Log in to your insurer’s member portal or visit Medicare.gov and navigate to “Prescription Drug Plans.” Most sites have a searchable formulary where you can type “Ubrelvy” or “ubrogepant.” If you don’t see it right away, look under “brand‑name drugs” or “non‑preferred tier.”

Key formulary terms you’ll see

• Preferred tier: Lower cost‑share, often a generic or widely used brand.
• Non‑preferred tier: Higher cost‑share, usually newer or specialty drugs like Ubrelvy.
• Step‑therapy: You must try another medication first (often a triptan) before the plan approves Ubrelvy.
• Prior authorization (PA): Your doctor must submit extra paperwork proving Ubrelvy is medically necessary.

Step‑by‑step guide to checking coverage

1. Log into your insurer’s website or the Medicare plan finder.
2. Enter “Ubrelvy” or the generic name “ubrogepant” in the search bar.
3. Note the tier, any step‑therapy requirements, and whether PA is required.
4. If you can’t find it, call the plan’s member services number (usually on the back of your card). Ask, “Is Ubrelvy on the formulary for my plan, and what is the cost‑share?”
5. Jot down the information—you’ll need it when you talk to your pharmacist or doctor.

Cost Stages Explained

Medicare drug plans have three cost‑sharing phases. Understanding them helps you predict exactly how much you’ll pay each month.

Deductible stage

Before your plan kicks in, you may need to meet a deductible. In 2025, the maximum deductible for Part D plans was $590. If you haven’t hit that amount yet, you’ll pay the full price of Ubrelvy (which, according to the manufacturer, is about $1,084.85 for a month’s supply) until the deductible is satisfied.

Initial coverage stage

Once the deductible is met, you move into the “initial coverage” phase. Most plans charge a 25 % coinsurance for non‑preferred drugs like Ubrelvy. That means if the plan’s price for a 30‑day supply is $24 (the average quoted by Ubrelvy’s own cost page), you’d pay roughly $6 out‑of‑pocket each month—but remember, the wholesale acquisition cost is higher, and some plans may have a higher tier price.

Catastrophic stage

When your out‑of‑pocket spending reaches the “donut hole” threshold (about $2,000 in 2025), you enter the catastrophic stage. Your share drops dramatically—often to just 5 % of the drug’s cost—so you’ll pay very little for the rest of the year.

Example cost breakdown

Coverage Phase	What You Pay (Typical)	Notes
Deductible (up to $590)	Full price – up to $1,084.85 per month	Pay until deductible met.
Initial coverage (25 % coinsurance)	~$6–$30 depending on plan tier	Based on $24 average price.
Catastrophic (after $2,000 out‑of‑pocket)	5 % of price (≈$12)	Very low cost for the rest of the year.

Savings Programs

Even with Medicare coverage, the price tag can still sting. Luckily, there are a few ways to soften the blow.

Extra Help & Low‑Income Subsidy (LIS)

If your income and assets fall below certain thresholds, you may qualify for the federal Extra Help program. This reduces or even eliminates the deductible, monthly premiums, and copays for Part D drugs. To see if you qualify, visit the Social Security website or call 1‑800‑772‑1213.

Why Ubrelvy’s own “Complete” Savings Card doesn’t work for Medicare

AbbVie offers a “Ubrelvy Complete” savings card that can bring the copay down to $0 for commercially insured patients. However, the fine print states the program is not available for anyone on Medicare, Medicaid, or any government‑funded plan. So, if you’re on a Medicare drug plan, you’ll need to rely on Extra Help or other state assistance.

State‑specific assistance

Some states run supplemental pharmacy assistance programs that can further lower out‑of‑pocket costs. It’s worth checking your state’s health department website or calling your local Medicaid office for details.

Prior Authorization & Quantity Limits

Many Medicare plans require a prior authorization (PA) for Ubrelvy. The criteria are fairly standard but worth knowing so you aren’t caught off‑guard.

When does Medicare need a PA for Ubrelvy?

Typically, the plan will ask for proof that you:

• Have a confirmed migraine diagnosis.
• Are using Ubrelvy for acute migraine treatment (with or without aura).
• Have tried and not responded to a triptan, or cannot take a triptan due to intolerance or contraindication.

These requirements mirror the prior‑authorization policy published by Blue Cross NC for Medicare Part D (2025). Your prescriber will need to submit documentation confirming these points.

Quantity limits and higher doses

Most plans set a monthly quantity limit (usually 30 tablets). If your doctor prescribes a higher dose, you’ll need to provide clinical justification—often a note explaining why standard dosing isn’t effective.

Sample PA script for providers

“Patient X has a documented history of chronic migraine, failed trials of two triptans, and continues to experience ≥4 migraine days per month despite optimized acute therapy. Ubrelvy 100 mg as needed is medically necessary to improve quality of life and reduce ED visits.”

Benefits vs. Risks of Medicare Coverage

It’s easy to focus just on the price tag, but let’s weigh the whole picture.

Benefits

• Rapid relief: Ubrelvy can work within 2 hours for many patients, a big win for those who can’t tolerate triptans.
• No opioid risk: It’s a non‑controlled substance, meaning no risk of dependence.
• Oral dosing: No injections or infusions—just a pill you can keep in your purse.

Risks & cost considerations

• Higher tier: As a brand‑only drug, it sits on a non‑preferred tier, which can raise copays.
• Drug interactions: Strong CYP3A4 inhibitors (e.g., ketoconazole) can raise Ubrelvy levels—always double‑check with your pharmacist.
• Out‑of‑pocket variability: Different Part D plans have different rules, so your cost may change if you switch plans at the annual enrollment period.

Real‑world example

Maria, a 68‑year‑old retired teacher from Ohio, was on a Medicare Advantage plan that placed Ubrelvy on a non‑preferred tier. Her initial out‑of‑pocket cost was $45 per month. After applying for Extra Help, her monthly cost dropped to $5. She reports going from “four migraine days a week” to “one or two,” dramatically improving her daily functioning.

Tips to Maximize Coverage & Lower Costs

Here are practical steps you can take right now.

Ask about alternative CGRP agents

If Ubrelvy feels pricey, ask your neurologist whether another CGRP antagonist (e.g., Aimovig or Emgality) is on a preferred tier in your plan. Sometimes a slight switch can save you a couple of dollars each month.

Shop the formulary annually

During the Medicare Open Enrollment period (October 15‑December 7), review the new plan options. One plan’s “non‑preferred” tier could become “preferred” the next year.

Use mail‑order pharmacies

Many Part D plans give you a 90‑day supply at a lower copay than a 30‑day fill. If your doctor writes a 90‑day prescription, you could cut your cost by up to 30 %.

Quick‑reference cheat sheet

• Log into your plan portal and search “Ubrelvy.”
• Note tier, PA requirement, and any step‑therapy rules.
• Check if you qualify for Extra Help.
• Ask your doctor to document prior triptan failure for PA.
• Consider 90‑day mail‑order fills.

Conclusion

Understanding Medicare Ubrelvy coverage is less about memorizing jargon and more about knowing where to look, what questions to ask, and how to use the tools available to you. If you have prescription drug coverage through a Part D plan or a Medicare Advantage plan, Ubrelvy can be covered—provided it’s on the formulary, you meet any prior‑authorization criteria, and you’re aware of the three cost‑sharing phases.

Take a few minutes this week to log into your plan’s website, verify Ubrelvy’s tier, and see if you qualify for Extra Help. Talk to your doctor about the documentation needed for a prior‑authorization, and don’t shy away from asking the pharmacist about mail‑order options.

When you arm yourself with this knowledge, you’ll spend less time worrying about bills and more time enjoying migraine‑free moments. Got questions or a story about navigating Medicare drug coverage? I’d love to hear from you in the comments—let’s keep the conversation going!