CHAMP has created the financial assistance guide below for anyone who has been prescribed Emgality by their healthcare provider. Emgality is one of three new CGRP inhibitors that were approved for the prevention of migraine in adults. If you or someone you know requires help with paying for treatment, please review the details provided below to see if you qualify for the manufacturer’s financial assistance programs and how best to access Emgality.ity.
Most insurance companies have added at least one or two of these CGRP inhibitors to the list of medicines they cover, but individual patients are still struggling to get the insurers to approve coverage of their prescribed CGRP inhibitor. Each pharmaceutical company is offering financial assistance programs to help help cover the cost of high copays. Each program is different and various programs exist to support patients with private, goverment-funded insurance, as well as the uninsured.
To help patients understand each program, the Coalition For Headache And Migraine Patients (CHAMP) has created Financial Assistance Guides for the three CGRP inhibitors. These guides have not been produced or approved by the medication manufacturers. CHAMP is not endorsing the use of any CGRP inhibitor over another, nor promoting the use of this new class of preventive medications for everyone with migraine disease. Every patient needs to consult their healthcare provider to determine if CGRP inhibitors are right for you.
Please note: This guide has not been produced or approved by the manufacturer of Emgality. CHAMP does not endorse the use of any CGRP inhibitor over another, nor promote the use of this new class of preventive medications for everyone with migraine disease. Please consult your healthcare provider to determine if CGRP inhibitors are right for you.
I Have Been Prescribed Emgality. What Financial Assistance Programs Exists To Help Me?
Find your insurance coverage and see what Financial Assistance Programs exist to help.
I Have a Private/Commercial Insurance Plan
This category includes insurance plans provided through an employer, purchased with subsidy support from the Affordable Care Act (Obamacare) or purchased privately.
Highlights of Emgality Savings Card
If you have commercial drug insurance, you may be able to pay as little as $0 for your first fill of Emgality. If your health plan covers Emgality, you may continue to pay as little as $0 per fill for up to 12 months. The program currently extends through December 2021. The Savings Card is subject to a maximum annual savings benefit of $4900. This means that you may be required to pay out of pocket depending on your health plan and copay model if the maximum annual cap is reached.
Anyone who has completed 12 months of Emgality on the Savings Card, will be notified via text by the Emgality team and required to activate a new Savings Card.
Emgality has coverage for over 90% of people through commercial insurance.
Steps to get your Savings Card
*To activate your Savings Card online, visit Emgality.com/savings. You can choose to either “Download a Savings Card”, or if you already have a physical savings card you can choose to “Activate your card”. You will then be prompted to complete the following steps:
Your HIPAA authorization is needed to allow Lilly to work on your
behalf to help you pay as little as possible for Emgality.
Congratulations on accessing your first dose of Emgality!
Lilly’s Prior Authorization support partners (CoverMyMeds) will work with your doctor to complete the correct forms as required by your insurance plan. To be a proactive and engaged patient, you should contact your doctor’s office to see if they have completed the Emgality prior authorization form on your behalf and your insurance company to see if they will be covering your prescribed medicine. If you have questions or problems, contact the Emgality Answers Center at 1-833-364-2548.
I Have Medicare, Medicaid or other Government Insurance Plan
The Emgality Savings Card is not available to patients whose medical insurance is provided by state or federal programs like Medicare, Medicaid or Tricare. This restriction is true for all three CGRP inhibitor medications.
The Federal Government does not allow people who are receiving insurance benefits through Medicare, Medicaid, etc. to use co-pay assistance, discount or savings cards offered by pharmaceutical companies. The intent is to steer patients to lower-cost generic drugs and not to support higher-cost brand-name drugs. Unfortunately, there are no generic/biosimilar medications in the class of CGRP inhibitors and won’t be for years to come.
Patients with Medicare Part D who meet all program eligibility criteria may receive Emgality free of charge from the Lilly Cares Foundation Patient Assistance Program. Some of the eligibility requirements are:
- Must be a permanent, legal resident of the US or Puerto Rico
- Must have been prescribed Emgality and have Medicare Part D
- Must not be enrolled in Medicaid, Medicare’s Extra Help
program or Veterans benefits
- Must have spent $1,100 on prescription medications as a
Medicare Part D patient
- Must have a household income under the Annual Income Limit:
|Total # Of Persons in your Household||Annual Adjusted Gross Income Limit (may not be more than)|
I Am Uninsured
The Emgality Savings Card is not available to patients who are uninsured. Patients without insurance who meet all program eligibility criteria may receive Emgality free of charge from the Lilly Cares Foundation Patient Assistance Program. Some of the eligibility requirements are:
Where do I turn if I am not eligible for a financial assistance program?
The Patient Advocate Foundation (a CHAMP participant organization) can be a helpful resource for patients and caregivers who are experiencing access challenges. PAF provides a suite of expert tips to help navigate insurance denials, appeals, and common barriers at: patientadvocate.org/migrainematters.
PAF also offers one-on-one case management assistance through its dedicated Migraine Careline for people living with migraine who experience access challenges. The Migraine Careline provides assistance with navigating eligibility and enrollment in disability benefits and overcoming insurance coverage and financial burdens that impact patient access to care.