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Emgality™ Financial Assistance Guide

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™.

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.

Piggy Bank

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 bridge coverage until the insurance company agrees to cover and/or to 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.

Speech Bubble

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.

I Have Been Prescribed Emgality™. What Financial Assistance Programs Exits To Help Me?

Private Insurance

I Have a Private/Commercial Insurance Plan

Savings card

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 your health plan covers Emgality, you may use the Emgality Savings Card and pay as little as $0 per month for up to 12 months.
  • The program currently extends through December 2020 and allows for re-enrollment in that time period if you reach your 12 months.
  • The Savings Card is subject to an annual maximum 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.

If your health plan has not yet decided to cover Emgality™ or denies coverage, you may still use the Emgality Savings Card and pay as little as $0 per month up to 12 months. The program currently extends through December 2020 and allows for re-enrollment in that time period if you reach your 12 months. Your doctor must submit a prior authorization AND you must activate your Savings Card.

Details about the Savings Card offer beyond 2020 is not yet available.

Steps To Get Your Savings Card

  • 1 Your doctor writes you a prescription for Emgality™.
  • 2 Obtain the Emgality Savings Card in the Patient Starter Guide, on the Emgality website, by phone (1-833-EMGALITY) or by texting Activate to 54559. The Patient Starter Guide specifically may be distributed to you at your doctor's office.
  • 3 Activate your Savings Card. You can activate online* at Emgality.com/savings, by texting "activate" to 54559 or over the phone by calling the Emgality Answers Center at 1-833-364-2548.
  • 4 Take your prescription (if your doctor did not call it in to your pharmacy) and your activated Emgality Savings Card to your local retail pharmacy to be filled. It is important to give your activated Emgality Savings Card to the pharmacist when you pick up your Emgality™ to ensure that you receive the offered savings. If you have any trouble or are ever told you must pay more than $0, please call The Emgality Answers Center at 1-833-364-2548.
  • 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:
  • 1 Answer the Savings Card eligibility questions – please confirm that you are a resident of the US or Puerto Rico who is 18 years of age or older, NOT enrolled in a government-funded prescription program.
  • 2 Provide your contact information.
  • 3 Read and accept the terms and conditions for Electronic Signatures in Global and National Commerce (“E-Sign”) Act Disclosure.
  • 4 Read and sign the HIPAA (Health Insurance Portability and Accountability Act) authorization**.
  • 5 You will receive a verification code via email. The verification code will need to be entered to complete your Savings Card activation.
  • 6 If you have a physical Savings Card, enter in the card information to complete activation.
  • 7 Your Savings Card will be emailed to you and may be printed. It is now activated and is ready to be used at your local pharmacy.

**Your HIPAA authorization is needed to allow Lilly to work on your
behalf to help you pay as little as possible for Emgality™.

Gammacore-Icons_FinAgGuide-Clipboard-2

Congratulations on accessing your first dose of Emgality™! Lilly's Prior Authorization support partners (CoverMyMeds and iAssist) 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.

Medicare/Medicaid

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 and Medicaid. 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
House
Total # Of Persons in your HouseholdAnnual Adjusted Gross Income Limit (may not be more than)
1$48,560
2$65,840
3$83,120
4$100,400
5$117,680
6$134,960

For more information and to apply, visit lillycares.com or call 1-800-545-6962.

Uninsured

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

House
Total # Of Persons in your HouseholdAnnual Adjusted Gross Income Limit (may not be more than)
1$48,560
2$65,840
3$83,120
4$100,400
5$117,680
6$134,960
  • 1 Must be a permanent, legal resident of the US or Puerto Rico
  • 2 Must have been prescribed Emgality and be uninsured
  • 3 Must not be enrolled in Medicaid, Medicare’s Extra Help program or Veterans benefits
  • 4 Must have a household income under the Annual Income Limit (see above)

Need More Help

Where do I turn if I need more help accessing this medicine?

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Patient Advocate Foundation

The Patient Advocate Foundation (a CHAMP member 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 direct case management services to patients with treatment access issues or financial challenges. Call 1-800-532-5274 to connect with support or visit: patientadvocate.org/gethelp.

Emgality™ Basics

ItemDescription
Brand NameEmgality™
Biologic Namegalcanezumab-gnlm
Pharmaceutical CompanyEli Lilly
Dosing & Administration1st dose of two 120 mg injections, then one 120 mg injection thereafter. Available in self-injectable pen or prefilled syringe.
Your doctor will determine which option is best for you.
IndicationAdults living with either chronic migraine (15 or more headache days per month) or episodic migraine (fewer than 15 headache days per month).
Full Prescribing Informationhttps://pi.lilly.com/us/emgality-uspi.pdf
WebsiteEmgality.com
HelplineThe Emgality Answers Center at 1-833-EMGALITY (1-833-364-2548), Monday through Friday, 9 am-8 pm ET.
Injection Training AvailableYes. Emgality offers various channels and options for injection training. Telephonic injection training with a registered nurse is available at The Emgality Answers Center (1-833-364-2548) Online instructions and an injection how-to video is available on the Emgality website. Additionally, patients can text INFO to 54559 to receive the injection how-to video to their mobile devices.
Sharps Container AvailableYes, order a free container at Emgality.com/taking-emgality
Home Delivery AvailableEmgality does not offer home delivery, however Emgality is available at your local pharmacy. Please call The Emgality Answers Center for more information.
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