Relpax

Generic: eletriptan

20MG, 40MG — Tablet

Antimigraine Agents — Quantity limits apply to all triptans

Also known as: RELPAX TABS 20MG, 40MG

Coverage by Insurer

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

Ambetter (Centene)

29 plans

Source: CMS QHP JSON · Formulary date: Jan 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Elite Bronze + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Everyday Bronze with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Elite Bronze with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Complete Gold with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Expanded Bronze + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Silver + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Gold + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Expanded Bronze with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Complete Gold via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Everyday Bronze via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Elite Bronze via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Clear Silver with $0 Insulin Options via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Expanded Bronze via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Silver via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Gold via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Everyday Bronze with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Elite Bronze with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Complete Gold with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Focused Silver with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Expanded Bronze with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Silver with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Gold with Atrium Health via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Enhanced Asthma/COPD Care Silver with $0 Drug Options + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Complete Gold + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Everyday Bronze + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Gold with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Standard Silver with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL
Focused Silver with Atrium Health + Vision + Adult Dental via eletriptan	Tier 2 - Generic	—	✓	✓	ST \| QL

Blue Cross Blue Shield Federal

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBS Federal Basic Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL
BCBS Federal Standard Option 2026	Tier 3 - Non-Preferred Brand	—	—	✓	QL

Blue Cross Blue Shield of NC

5 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
BCBSNC Blue Local 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Care 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Value 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Advantage 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL
BCBSNC Blue Home with UNC Health Alliance 2026	Tier 2 - Medium Cost Generic/Brand	—	—	✓	QL

Cigna

1 plan

Source: PDF · Formulary date: Jan 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Cigna Plus NC 4-Tier Formulary 2026 via eletriptan	Tier 2 - Preferred Brand	—	—	✓	QL

Medicare Part D

50 plans

Source: CMS QHP JSON · Formulary date: Mar 18, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
Aetna Medicare Signature (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Dual (HMO D-SNP) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Value Plus (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Prime (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature Care (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Full Dual Care (HMO D-SNP) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Enhanced (HMO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Enhanced (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Enhanced (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature Extra (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature Giveback (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Signature (PPO) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Chronic Care (HMO C-SNP) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Aetna Medicare Chronic Care Value (HMO C-SNP) via eletriptan	Tier 2 - Generic	—	—	✓ 12 per 30 days	QL
Alignment Health smartHMO (HMO) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health Heart & Diabetes NCPlus (HMO-POS C-SNP) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health Platinum Select (HMO) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health Heart & Diabetes Care (HMO C-SNP) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health AVA (PPO) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health Platinum (HMO) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Alignment Health NC Duals (HMO-POS D-SNP) via eletriptan	Tier 3 - Preferred Brand	—	—	✓ 12 per 30 days	QL
Humana Gold Plus SNP-DE H1036-331 (HMO D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H1036-335 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice Giveback H5216-017 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice H5216-211 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Full Access H5525-034 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice Giveback H5525-035 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice SNP-DE H5525-036 (PPO D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice H5525-049 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice H5525-050 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice H5525-070 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Dual Select H5525-072 (PPO D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
HumanaChoice H5525-083 (PPO) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H6622-025 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H6622-026 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Dual Select H6622-027 (HMO-POS D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H6622-057 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H6622-060 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Choice H8145-004 (PFFS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H6622-061 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus - Diabetes and Heart (HMO C-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H1036-137 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus SNP-DE H1036-167 (HMO D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus H1036-233 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Dual Select H1036-307 (HMO D-SNP) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL
Humana Gold Plus Giveback H1036-318 (HMO-POS) via eletriptan	Tier 4 - Non-Preferred	—	—	✓ 9 per 30 days	QL

NC Medicaid PDL

2 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC Medicaid Preferred Drug List 2026 via eletriptan	Non-Preferred	—	—	—	None
NC Medicaid Preferred Drug List 2026	Non-Preferred	—	—	—	None

NC State Health Plan

3 plans

Source: PDF · Formulary date: Apr 1, 2026 · Checked: 22 hours, 14 minutes ago

Plan	Tier	Prior Auth	Step Therapy	Quantity Limit	Restrictions
NC State Health Plan - 80/20 Plus PPO 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL
NC State Health Plan - HDHP 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL
NC State Health Plan - 70/30 Standard PPO 2026	Tier 3 - Non-Preferred Brand	✓	—	✓	PA \| QL