eletriptan hydrobromide

20 mg, 40 mg — Tablet

Also known as: eletriptan hydrobromide tabs 20mg, 40mg eletriptan hydrobromide tab 20 mg (base equivalent), 40 mg (base equivalent)

Informational only — Coverage rules change frequently; verify tier placement and restrictions with your plan or pharmacy before acting.

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Focus 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Standard Option 2026	Tier 1 - Generic	—	—	✓	QL
BCBS Federal Basic Option 2026	Tier 1 - Generic	—	—	✓	QL

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 1 - Preferred Generic	✓	—	✓	PA \| QL

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 22 hours, 16 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
UnitedHealthcare NC Individual & Family 2026	Tier 3 - Mid-Range Cost	—	✓	✓	ST \| QL