Relpax
Generic: eletriptan
20MG, 40MG — Tablet
Antimigraine Agents — Quantity limits apply to all triptans
Also known as:
RELPAX TABS 20MG, 40MG
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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| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Focused Silver 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 |
|
Everyday Bronze with Atrium Health + Vision + Adult Dental
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Elite Bronze + Vision + Adult Dental
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze + Vision + Adult Dental
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Complete Gold + Vision + Adult Dental
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 |
|
Standard Gold with Atrium Health
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Standard Silver with Atrium Health
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Everyday Bronze
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Complete Gold with Atrium Health
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Standard Expanded Bronze with Atrium Health
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Enhanced Asthma/COPD Care Silver with $0 Drug Options
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 Gold with Atrium Health + Vision + Adult Dental
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 |
|
Focused Silver with Atrium Health
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Complete Gold
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Standard Silver with Atrium Health + 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 |
|
Standard Gold + Vision + Adult Dental
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Standard Silver + Vision + Adult Dental
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
Standard Expanded Bronze + 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 |
AmeriHealth Caritas NC
10 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
AmeriHealth Caritas Next Bronze Premier + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace Low + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Gold Premier + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Silver Essential + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Silver Premier + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Silver Off-Marketplace High + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Gold Signature + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Silver Signature + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Bronze Signature + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
|
AmeriHealth Caritas Next Bronze Essential + No Referrals
via eletriptan |
Tier 2 - Generic | — | ✓ | ✓ | ST | QL |
Blue Cross Blue Shield Federal
2 plansBlue Cross Blue Shield of NC
5 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| BCBSNC Blue Value 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Local 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Home with UNC Health Alliance 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Advantage 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
| BCBSNC Blue Care 2026 | Tier 2 - Medium Cost Generic/Brand | — | — | ✓ | QL |
Medicare Part D
50 plans| 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 Enhanced (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 Signature Care (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 Giveback (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 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 |
|
Aetna Medicare Value Plus (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 Signature (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 Extra (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 |
|
Alignment Health smartHMO (HMO)
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 |
|
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 |
|
Humana Gold Plus H6622-057 (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 H6622-060 (HMO-POS)
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 Choice H8145-004 (PFFS)
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 |
|
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 |
NC Medicaid PDL
2 plansNC State Health Plan
3 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
| NC State Health Plan - 70/30 Standard PPO 2026 | Tier 3 - Non-Preferred Brand | ✓ | — | ✓ | PA | QL |
| 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 |
Oscar Health
28 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
Secure
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic Standard
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic Standard
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Classic Standard
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic Standard | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic Standard | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Classic Standard | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic 4700
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple PCP Saver
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Elite Saver Plus
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Diabetes
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Secure | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Classic 4700 | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Elite + PCP Saver Plus | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Classic | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Diabetes | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple PCP Saver | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Gold Elite Saver Plus | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Chronic Care CKM | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Bronze Simple Diabetes | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Breathe Easy with Enhanced COPD Benefits | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Chronic Care CKM | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
Silver Simple Women's Health with Menopause Benefits | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
AIAN Cost Share
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
|
AIAN Cost Share | with Atrium Health
via eletriptan |
Tier 2 - Generic | — | — | ✓ | QL |
UnitedHealthcare
13 plans| Plan | Tier | Prior Auth | Step Therapy | Quantity Limit | Restrictions |
|---|---|---|---|---|---|
|
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Silver Value ($0 Virtual Urgent Care, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Silver Standard (No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Bronze Standard (No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Gold Advantage + ($0 Virtual Urgent Care, $1 Tier 2 Rx, Dental + Vision, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Bronze Standard+ Dental + Vision (No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Gold Advantage ($0 Virtual Urgent Care, $1 Tier 2 Rx, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Silver Value + ($0 Virtual Urgent Care, Dental + Vision, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Gold Standard (No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |
|
UHC Silver Advantage + ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals)
via eletriptan |
Tier 3 - Preferred Brand | — | ✓ | ✓ | ST | QL |