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You searched for Eletriptan Tablet.

Eletriptan At a Glance
Covered:	Yes
Your Cost*:	$$$$
Notices?:	Yes
* Your cost reflects copayment amount for drug. Individuals with high deductible plans may pay full cost of drug until deductible is met.

Strength:

eletriptan 20 mg tablet

Eletriptan is a covered medication with a Tier PBG copayment. ($$$$)
Notice: Eletriptan requires step therapy. (ST)
Notice: Eletriptan has a quantity limit. (QL)

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Sumatriptan Succinate	Sumatriptan Subcutaneous Solution	Yes	Generic	$$$$	No
Naratriptan	Naratriptan Tablet	Yes	Generic	$$$$	Yes
Rizatriptan	Rizatriptan Disintegrating Tablet	Yes	Generic	$$$$	Yes
Rizatriptan	Rizatriptan Tablet	Yes	Generic	$$$$	Yes
Sumatriptan Succinate	Sumatriptan Tablet	Yes	Generic	$$$$	Yes
Sumatriptan Succinate	Sumatriptan Subcutaneous Syringe	Yes	Generic	$$$$	Yes
Sumatriptan Succinate	Sumatriptan Subcutaneous Pen Injector	Yes	Generic	$$$$	Yes
Zolmitriptan	Zolmitriptan Disintegrating Tablet	Yes	Generic	$$$$	Yes
Zolmitriptan	Zolmitriptan Tablet	Yes	Generic	$$$$	Yes
Aimovig Autoinjector	Aimovig Autoinjector Subcutaneous Auto-Injector	Yes	Brand	$$$$	Yes
Ajovy Autoinjector	Ajovy Autoinjector Subcutaneous Auto-Injector	Yes	Brand	$$$$	Yes
Ajovy Syringe	Ajovy Syringe Subcutaneous	Yes	Brand	$$$$	Yes
Almotriptan Malate	Almotriptan Malate Tablet	Yes	Generic	$$$$	Yes
Eletriptan	Eletriptan Tablet	Yes	Generic	$$$$	Yes
Emgality Syringe	Emgality Subcutaneous Syringe	Yes	Brand	$$$$	Yes
Emgality Pen	Emgality Pen Subcutaneous Pen Injector	Yes	Brand	$$$$	Yes
Frovatriptan	Frovatriptan Tablet	Yes	Generic	$$$$	Yes
Migragesic IDA	Migragesic IDA Capsule	Yes	Brand	$$$$	No
Nodolor	Nodolor Capsule	Yes	Brand	$$$$	No
Nurtec ODT	Nurtec ODT Disintegrating Tablet	Yes	Brand	$$$$	Yes
Qulipta	Qulipta Tablet	Yes	Brand	$$$$	Yes
Sumatriptan	Sumatriptan Nasal Spray	Yes	Generic	$$$$	Yes
Sumatriptan Succinate	Sumatriptan Subcutaneous Cartridge (Refill)	Yes	Generic	$$$$	Yes
Sumatriptan Succinate	Sumatriptan Subcutaneous Pen Injector	Yes	Generic	$$$$	Yes
Ubrelvy	Ubrelvy Tablet	Yes	Brand	$$$$	Yes
Zolmitriptan	Zolmitriptan Nasal Spray	Yes	Generic	$$$$	Yes
Zomig	Zomig Nasal Spray	Yes	Brand	$$$$	Yes
Dihydroergotamine	Dihydroergotamine Nasal Spray	Yes	Generic	$$$$	Yes
Dihydroergotamine	Dihydroergotamine Injection Solution	Yes	Generic	$$$$	Yes
Reyvow	Reyvow Tablet	Yes	Brand	$$$$	Yes
Trudhesa	Trudhesa Nasal Spray	Yes	Brand	$$$$	Yes

Drug Name	Drug Form	Covered	Type	Your Cost*	Notices?
Alsuma	Alsuma Subcutaneous Pen Injector	No	Brand	$$$$	No
Amerge	Amerge Tablet	No	Brand	$$$$	No
Axert	Axert Tablet	No	Brand	$$$$	No
Brekiya	Brekiya Subcutaneous Auto-Injector	No	Brand	$$$$	No
Cafergot	Cafergot Tablet	No	Brand	$$$$	No
Cambia	Cambia Oral Powder Packet	No	Brand	$$$$	No
D.H.E.45	D.H.E.45 Injection Solution	No	Brand	$$$$	No
Diclofenac Potassium	Diclofenac Potassium Oral Powder Packet	No	Generic	$$$$	No
Elyxyb	Elyxyb Oral Solution	No	Brand	$$$$	No
Ergomar	Ergomar Sublingual Tablet	No	Brand	$$$$	No
Ergotamine-Caffeine	Ergotamine-Caffeine Tablet	No	Generic	$$$$	No
Frova	Frova Tablet	No	Brand	$$$$	No
Imitrex	Imitrex Tablet	No	Brand	$$$$	No
Imitrex	Imitrex Subcutaneous Solution	No	Brand	$$$$	No
Imitrex	Imitrex Nasal Spray	No	Brand	$$$$	No
Imitrex Statdose Pen	Imitrex Statdose Pen Subcutaneous Pen Injector	No	Brand	$$$$	No
Imitrex Statdose Refill	Imitrex Statdose Refill Subcutaneous Cartridge	No	Brand	$$$$	No
Isomethepten-Caf-Acetaminophen	Isometheptene-Caffeine-Acetaminophen Tablet	No	Generic	$$$$	No
Maxalt	Maxalt Tablet	No	Brand	$$$$	No
Maxalt-MLT	Maxalt-MLT Disintegrating Tablet	No	Brand	$$$$	No
Migergot	Migergot Rectal Suppository	No	Brand	$$$$	No
Migranal	Migranal Nasal Spray	No	Brand	$$$$	No
Migranow	Migranow Kit, Gel And Tablet	No	Brand	$$$$	No
Onzetra Xsail	Onzetra Xsail Powder For Nasal Inhalation	No	Brand	$$$$	No
Prodrin	Prodrin Tablet	No	Brand	$$$$	No
Relpax	Relpax Tablet	No	Brand	$$$$	No
Sumatriptan-Naproxen	Sumatriptan-Naproxen Tablet	No	Generic	$$$$	No
Sumavel Dosepro	Sumavel Dosepro Subcutaneous Needle-Free Injector	No	Brand	$$$$	No
Symbravo	Symbravo Tablet	No	Brand	$$$$	No
Tosymra	Tosymra Nasal Spray	No	Brand	$$$$	No
Treximet	Treximet Tablet	No	Brand	$$$$	No
Zavzpret	Zavzpret Nasal Spray	No	Brand	$$$$	No
Zecuity	Zecuity Transdermal Iontophoretic Patch	No	Brand	$$$$	No
Zembrace Symtouch	Zembrace Symtouch Subcutaneous Pen Injector	No	Brand	$$$$	No
Zomig	Zomig Tablet	No	Brand	$$$$	No
Zomig ZMT	Zomig ZMT Disintegrating Tablet	No	Brand	$$$$	No

Alternative Drug Information

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As a member, you will have all the resources you need to manage your health:

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	$0 preventive care that covers many health services for adults and children at 100 percent.¹
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¹Preventive care will be covered at 100 percent only when it is received from a participating provider and it is billed as preventive. A separate cost share may apply if additional medical services are received during the same visit or if your preventive care appointment becomes diagnostic in nature.

²Preventive medications on UPMC Health Plan’s Advantage Choice formulary will be covered with no cost share for members who meet certain criteria in accordance with the Patient Protection and Affordable Care Act of 2010.

³Go to www.upmchealthplan.com/BEST for award information.

⁴For details, visit upmchp.us/networkaccess.

⁵UPMC virtual counseling is available to UPMC Health Plan members who are located in Pennsylvania at the time of the visit. The service is available to members of your household who are 18 years old and older. If further counseling is needed, the counselor may refer you or your household members to relevant community resources.

⁶UPMC Health Plan members who are in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider, subject to availability and discretion of the provider. Members located outside of Pennsylvania at the time of service or those who select Talk Therapy or Psychiatry services will receive care from a provider employed or contracted by Online Care Network II PC (OCN), also known as Amwell Medical Group. OCN is not an affiliate of UPMC. Limitations may apply for members of ASO plans that have opted out of coverage. Providers are not available to treat members who are in Puerto Rico.

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You searched for Eletriptan Tablet.

Alternative drugs to Eletriptan may be available. Review this list with your doctor.

These alternative drugs are not covered.