| Drug Name | Covered | Not Covered |
|---|---|---|
| Nurtec | $0 30 day free trial |
- |
| Ubrelvy | $0 60 day free trial |
- |
| Qulipta | $0 60 day free trial |
- |
| Elyxyb | $25 | - |
| Zavzpret | $0 | - |
| Aimovig | $5 | - |
| Ajovy | $15 | $150 |
| Emgality | $35 30 day free trial |
- |
| Botox | $0 | - |
| Nuedexta | $20 | - |
| Aubagio (g) | $0 | - |
| Gilenya (g) | $0 | - |
| Kesimpta | $0 | - |
| Avonex | $0 | - |
| Copaxone (g) | $0 | - |
| Xcopri | $20 30 day free trial |
- |
| Austedo | $0 30 day free trial |
- |
| Caplyta | $0 | - |
| Aplenzin | $0 | $100 |
| Rexulti | $0 | - |
| Trintellix | $10 | - |
| Pristiq | $4 | - |
| Vraylar | $0 | - |
| Abilify Maintena | $10 | - |
| Invega Sustenna | $10 | - |