In 2018, a new class of medications was approved by the FDA for the prevention of migraine in adults. These drugs are referred to as calcitonin gene-related peptide (CGRP) inhibitors. There are currently multiple CGRP medications on the market. Dosing, frequency of use and method of action vary.
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 cover the cost of high copays. Each program is different and various programs exist to support patients with private, government-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 medications used to treat migraine and cluster diseases. This guide has not been produced or approved by the manufacturer. CHAMP is not endorsing the use of any CGRP inhibitor over another, nor promoting the use of this 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 Vyepti. 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 Vyepti Copay Assistance Program
If you are 17 years or older, your health plan covers Vyepti, and your health plan is a commercial plan, you could pay as little as $5 per infusion up to a $4000 annual cap. This applies to your out-of-pocket costs, for the product, including co-insurance and copayments for Vyepti. You are responsible for costs above the $4000 annual maximum. You should confirm your out-of-pocket cost with your physician or specialty pharmacy.
Offer will automatically renew each calendar year. If you no longer wish to participate in the Program, please call 1-833-4-VYEPTI and cancel anytime.
Steps to Receive Co-Pay Assist Savings Offer
Congratulations on accessing your first dose of Vyepti! Lundbeck will now be working behind the scenes to get your doctor to complete a prior authorization form and to get your insurance company to cover your Vyepti prescription. To be a proactive and engaged patient, you should contact your doctor’s office to see if they have completed the Vyepti 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 encounter problems, contact the helpline at 1-833-4-VYEPTI.
I Have Medicare, Medicaid or other Government Insurance Plan
The Vyepti Copay Assistance Program 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 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.
I Am Uninsured
The Vyepti Copay Assistance Program is not available to patients who are uninsured.
Uninsured patients or those without insurance coverage for Vypeti can find more information about Lundbeck Migraine Patient Assistance Program by calling the Support Center at 877-288-9125 or on the Lundbeck website at lundbeck.com/us/our-commitment/patient-assistance. The support center will assess each patient on a case-by-case basis to determine whether he or she meets the program’s eligibility criteria.
Where do I turn if I am not eligible for a financial assistance program?
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 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.