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Ubrogepant (Ubrelvy) — plans on this site that list it on Tier 5
141 plans published on this site list this drug on Tier 5, grouped by company. Plans are sold by county — the service area under each plan shows where it is offered.
Align powered by Sanford Health Plan
2 plans on this site
- Align SecureChoice (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties
- Align SecureChoice Gold (PPO) — Offered in IA: Lyon, O'Brien, Osceola, Sioux; ND: 17 counties; SD: 19 counties
AlohaCare
1 plan on this site
- AlohaCare Advantage Plus (HMO D-SNP) — Offered in HI: Hawaii, Honolulu, Kalawao, Kauai, Maui
AmeriHealth
2 plans on this site
- AmeriHealth Medicare Classic Rx (HMO) — Offered in NJ: Atlantic, Burlington, Camden, Gloucester, Mercer, Middlesex, Ocean
- AmeriHealth Medicare Core (PPO) — Offered in NJ: Camden
AmeriHealth Caritas VIP Care (HMO-D-SNP)
1 plan on this site
- AmeriHealth Caritas VIP Care Choice (HMO D-SNP) — Offered in DE: Kent, New Castle, Sussex
Blue Care Network
4 plans on this site
- BCN Advantage Classic (HMO-POS) — Offered in MI: 24 counties
- BCN Advantage ConnectedCare (HMO) — Offered in MI: 11 counties
- BCN Advantage Prestige (HMO-POS) — Offered in MI: 24 counties
- BCN Advantage Prime Value (HMO-POS) — Offered in MI: Berrien, Branch, Calhoun, Gratiot, Hillsdale, Jackson, Monroe, Montcalm, St. Joseph, Van Buren
Blue Cross Blue Shield of Arizona (AZ Blue)
3 plans on this site
- Blue Best Life Classic (HMO) — Offered in AZ: Maricopa, Pinal
- Blue Best Life Plus (HMO) — Offered in AZ: Maricopa, Pinal
- Blue Best Life Select (HMO) — Offered in AZ: Maricopa, Pinal
Blue Cross Blue Shield of Michigan
8 plans on this site
- Medicare Plus Blue + Meijer (PPO) — Offered in MI: 25 counties
- Medicare Plus Blue Assure (PPO) — Offered in MI: 29 counties
- Medicare Plus Blue Essential (PPO) — Offered in MI: Berrien, Branch, Calhoun, Gratiot, Hillsdale, Jackson, Monroe, Montcalm, St. Joseph, Van Buren
- Medicare Plus Blue Giveback (PPO) — Offered in MI: 27 counties
- Medicare Plus Blue Secure (PPO) — Offered in MI: 27 counties
- Medicare Plus Blue Signature (PPO) — Offered in MI: 29 counties
- Medicare Plus Blue Value (PPO) — Offered in MI: 56 counties
- Medicare Plus Blue Vitality (PPO) — Offered in MI: 29 counties
Blue Cross Blue Shield of South Carolina
2 plans on this site
- BlueCross Total (PPO) — Offered in SC: 12 counties
- BlueCross Total Value (PPO) — Offered in SC: 15 counties
Blue Cross and Blue Shield of North Carolina
5 plans on this site
- Blue Medicare Enhanced (HMO-POS) — Offered in NC: 42 counties
- Blue Medicare Essential (HMO) — Offered in NC: 80 counties
- Blue Medicare Essential Plus (HMO-POS) — Offered in NC: 42 counties
- Blue Medicare PPO Enhanced (PPO) — Offered in NC: 61 counties
- Healthy Blue + Medicare (HMO-POS D-SNP) — Offered in NC: 100 counties
Capital Blue Cross
6 plans on this site
- Capital Blue Cross Basic (PPO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
- Capital Blue Cross Complete (PPO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
- Capital Blue Cross Enhanced (PPO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
- Capital Blue Cross Essential (HMO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
- Capital Blue Cross Select (PPO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
- Capital Blue Cross Value (PPO) — Offered in PA: Centre, Dauphin, Juniata, Mifflin, Perry
CareOregon Advantage
1 plan on this site
- CareOregon Advantage Plus (HMO D-SNP) — Offered in OR: Clackamas, Columbia, Jackson, Multnomah, Washington
Clover Health
8 plans on this site
- Clover Health Choice (PPO) — Offered in NJ: 12 counties
- Clover Health Choice Giveback (PPO) — Offered in NJ: 20 counties
- Clover Health Choice Value (PPO) — Offered in NJ: 12 counties
- Clover Health Classic (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Passaic, Union
- Clover Health LiveHealthy (PPO) — Offered in GA: 151 counties
- Clover Health LiveHealthy Giveback (PPO) — Offered in GA: 139 counties; SC: 12 counties
- Clover Health LiveHealthy Premier (PPO) — Offered in GA: 151 counties
- Clover Health Value (HMO) — Offered in NJ: Atlantic, Bergen, Essex, Hudson, Middlesex, Passaic, Union
Fallon Health
3 plans on this site
- Fallon Medicare Plus Blue (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
- Fallon Medicare Plus Green (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
- Fallon Medicare Plus Orange (HMO) — Offered in MA: Bristol, Essex, Middlesex, Norfolk, Plymouth, Suffolk
First Choice VIP Care (HMO D-SNP)
1 plan on this site
- First Choice VIP Care (HMO D-SNP) — Offered in SC: 46 counties
Great Plains Medicare Advantage
3 plans on this site
- Great Plain Medicare Advantage Gold (HMO I-SNP) — Offered in IA: Fremont, Harrison, Lyon, Mills, Montgomery, Plymouth, Pottawattamie, Shelby; ND: 19 counties; SD: 23 counties
- Great Plains Medicare Advantage (HMO I-SNP) — Offered in NE: 56 counties
- Great Plains Medicare Advantage Gold (HMO I-SNP) — Offered in NE: 56 counties
Health Alliance Plan by Henry Ford Health
12 plans on this site
- HAP Medicare Complete Assist (PPO D-SNP) — Offered in MI: 40 counties
- HAP Medicare Complete Duals (HMO D-SNP) — Offered in MI: 39 counties
- HAP Medicare Connect (HMO) — Offered in MI: 61 counties
- HAP Medicare Diabetes and Heart (HMO C-SNP) — Offered in MI: 61 counties
- HAP Medicare Explore (PPO) — Offered in MI: 60 counties
- HAP Medicare Prime (PPO) — Offered in MI: 60 counties
- HAP Medicare Superior (HMO) — Offered in MI: 61 counties
- HAP Member Assist (PPO) — Offered in MI: 60 counties
- HAP Senior Plus (HMO-POS) — Offered in MI: 61 counties
- HAP Senior Plus (PPO) — Offered in MI: 60 counties
- HAP Senior Plus Henry Ford Tiered Access (HMO) — Offered in MI: Genesee, Hillsdale, Jackson, Lapeer, Macomb, Oakland, Wayne
- Henry Ford Select (HMO) — Offered in MI: Genesee, Hillsdale, Jackson, Lapeer, Macomb, Oakland, Wayne
Health New England Medicare Advantage Plans
6 plans on this site
- Health New England Medicare Compass (PPO) — Offered in MA: Franklin, Hampden, Hampshire
- Health New England Medicare Plus (HMO) — Offered in MA: Berkshire, Franklin, Hampden, Hampshire
- Health New England Medicare Premium (HMO) — Offered in MA: Berkshire, Franklin, Hampden, Hampshire
- Health New England Medicare Select (HMO) — Offered in MA: Franklin, Hampden, Hampshire
- Health New England Medicare Standard (HMO) — Offered in MA: Berkshire
- Health New England Medicare Value (HMO) — Offered in MA: Franklin, Hampden, Hampshire
Independence Blue Cross
8 plans on this site
- Keystone 65 Assured Rx (HMO) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
- Keystone 65 Basic Rx (HMO) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
- Keystone 65 Essential Rx (HMO-POS) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
- Keystone 65 Focus Rx (HMO-POS) — Offered in PA: Chester, Delaware, Montgomery
- Keystone 65 Preferred Rx (HMO) — Offered in PA: Chester, Delaware, Montgomery
- Keystone 65 Select Rx (HMO) — Offered in PA: Chester, Delaware, Montgomery
- Personal Choice 65 Achieve Rx (PPO) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
- Personal Choice 65 Rx (PPO) — Offered in PA: Chester, Delaware, Montgomery
Independent Health
6 plans on this site
- Independent Health's Assure Advantage (HMO C-SNP) — Offered in NY: Erie
- Independent Health's Encompass 65 RED 042 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
- Independent Health's Encompass 65 RED 044 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
- Independent Health's Encompass 65 RED 045 (HMO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
- Independent Health's Medicare Family Choice (HMO I-SNP) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
- Independent Health's Medicare Passport Connect (PPO) — Offered in NY: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, Wyoming
KelseyCare Advantage
2 plans on this site
- KelseyCare Advantage Freedom (HMO-POS) — Offered in TX: 13 counties
- KelseyCare Advantage Signature (HMO) — Offered in TX: Brazoria, Fort Bend, Galveston, Harris, Montgomery
Mass General Brigham Health Plan
3 plans on this site
- Mass General Brigham Advantage Core (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
- Mass General Brigham Advantage Plus (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
- Mass General Brigham Advantage Secure (HMO-POS) — Offered in MA: Bristol, Dukes, Essex, Middlesex, Nantucket, Norfolk, Plymouth, Suffolk, Worcester
MyAdvocate Medicare Advantage
2 plans on this site
- MyAdvocate Medicare Advantage GOLD (HMO-POS) — Offered in NE: 21 counties
- MyAdvocate Medicare Advantage SILVER (HMO-POS) — Offered in NE: 21 counties
Network Health Medicare Advantage Plans
7 plans on this site
- Network Health Anywhere (PPO) — Offered in WI: Kenosha, Milwaukee, Ozaukee, Racine, Washington, Waukesha
- Network Health Cares (PPO D-SNP) — Offered in WI: 24 counties
- Network Health Choice (PPO) — Offered in WI: 21 counties
- Network Health Go (PPO) — Offered in WI: Milwaukee, Ozaukee, Racine, Washington, Waukesha
- Network Health PlusRx (PPO) — Offered in WI: 21 counties
- Network Health PremierRx (PPO) — Offered in WI: 21 counties
- Network Health Select (PPO) — Offered in WI: 21 counties
PrimeTime Health Plan
3 plans on this site
- PrimeTime Health Plan Aultimate (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
- PrimeTime Health Plan Classic (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
- PrimeTime Health Plan Plus (HMO-POS) — Offered in OH: Carroll, Columbiana, Harrison, Holmes, Mahoning, Medina, Portage, Stark, Summit, Wayne
Quartz Medicare Advantage (HMO)
14 plans on this site
- Gundersen MN Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen MN Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in MN: Fillmore, Houston, Wabasha
- Gundersen Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: La Crosse
- Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- Gundersen Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in IA: Allamakee, Fayette, Winneshiek; WI: Buffalo, La Crosse, Monroe, Pepin, Trempealeau
- UW Health Quartz Med Advantage Basic D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Core D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Dual Eligible (HMO D-SNP) — Offered in WI: Dane
- UW Health Quartz Med Advantage Elite D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
- UW Health Quartz Med Advantage Value D (w/Rx) (HMO) — Offered in WI: Columbia, Dane, Green
Samaritan Advantage Health Plans
1 plan on this site
- Samaritan Dual Advantage (HMO D-SNP) — Offered in OR: Benton, Lincoln, Linn
Security Health Plan of Wisconsin, Inc.
4 plans on this site
- Esteem Rx (HMO) — Offered in WI: 33 counties
- Esteem Rx Gold (HMO-POS) — Offered in WI: 33 counties
- Esteem Rx Silver (HMO-POS) — Offered in WI: 33 counties
- Legacy Rx (HMO-POS) — Offered in WI: 33 counties
South Country Health Alliance
2 plans on this site
- AbilityCare (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca
- SeniorCare Complete (HMO D-SNP) — Offered in MN: Brown, Dodge, Goodhue, Sibley, Steele, Wabasha, Waseca
Tufts Health Plan
6 plans on this site
- Tufts Medicare Preferred HMO Basic Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Prime Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Prime Rx Plus (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred HMO Smart Saver Rx (HMO) — Offered in MA: Bristol, Essex, Norfolk, Plymouth, Suffolk
- Tufts Medicare Preferred HMO Value Rx (HMO) — Offered in MA: Barnstable, Bristol, Middlesex, Norfolk, Plymouth
- Tufts Medicare Preferred PPO RX (PPO) — Offered in MA: Bristol, Essex, Hampden, Hampshire, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
Ultimate Health Plans
5 plans on this site
- Advantage Care COPD by Ultimate (HMO C-SNP) — Offered in FL: 12 counties
- Advantage Care by Ultimate (HMO C-SNP) — Offered in FL: Citrus, Hernando, Pasco
- Advantage Plus by Ultimate (Full) (HMO D-SNP) — Offered in FL: 16 counties
- Advantage Plus by Ultimate (Partial) (HMO D-SNP) — Offered in FL: 16 counties
- Premier by Ultimate (HMO) — Offered in FL: Citrus, Hernando, Indian River, Pasco, St. Lucie
VISTA Health Plan Inc.
2 plans on this site
- Amerihealth Caritas VIP Care (HMO D-SNP) — Offered in PA: 62 counties
- Keystone First VIP Choice (HMO D-SNP) — Offered in PA: Bucks, Chester, Delaware, Montgomery, Philadelphia
WyoBlue Advantage
2 plans on this site
- WyoBlue Advantage Enhanced PPO (PPO) — Offered in WY: 23 counties
- WyoBlue Advantage Essential PPO (PPO) — Offered in WY: 23 counties
eternalHealth
6 plans on this site
- eternalHealth Catalina (HMO) — Offered in AZ: Pima
- eternalHealth Forever (HMO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Freedom (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Give Back (PPO) — Offered in MA: Bristol, Middlesex, Norfolk, Plymouth, Suffolk, Worcester
- eternalHealth Harmony (HMO) — Offered in AZ: Graham, Maricopa, Pinal
- eternalHealth Horizon (HMO) — Offered in AZ: Graham, Maricopa, Pima, Pinal
A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage.
Source: CMS Prescription Drug Plan Formulary data + this site's published plan records · List built 2026-11-08