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CGRPs and Medicaid

I recently had a discussion with a neurologist friend about my lifelong migraines that seem to have become more of a cluster headache situation in the past five years. He said to ask my doc about CGRPs. I’ve been excited about my upcoming appointment until it hit me that Medicaid may not cover these. All my covered meds are generics… Does anyone here have prior experience? Thanks in advance!

  1. Hi there! Affording the CGRPs can be tricky right now, for sure. We have an article about it that might be useful: https://migraine.com/living-migraine/new-treatments-insurance-cost-barriers?_sp=ccabb475-b4aa-41e4-8cda-a794264d5fa3.1625173686296

    There are also coupon programs that could help -- you can check out the official website for the drug you're considering for info on that.

    Cluster headaches are a separate condition from migraines -- it's possible to have both migraines and cluster headaches. One of our advocates, Ashley, wrote a great piece explaining this earlier in the year: https://migraine.com/living-migraine/cluster-headache-differences

    I hope that gives you a little clarity. We're here if you have more questions. I hope you can get a good deal on the CGRPs and that they work well! -Melissa, migraine.com team

    1. Hi there- are you meaning Medicare? There are some Medicare plans that cover some of the CGRPs but most are considered tier 4 so will cost in the neighborhood of $100/per injection (IF they are covered). In many cases they are not covered, so it will depend on your plan. I'm on United (Medicare) and Emgality is covered, but it is tier 4, as I said. Because CGRPs don't work for everyone, it would be worth you trying the treatment first through a free sample program before making any changes in your coverage plans (if your plan is otherwise working for you). Most of the CGRPs have a free trial program where you can enroll and get a savings card that entitles you to up to a year of free injections. Hope this helps. Please let us know if you have other questions. Warmly, Holly (migraine.com team).

      1. Thank you both. Yes, I’m unfortunately on expanded Medicaid in my state.

        1. Ugh- so sorry. Yes, I've heard cluster type are very severe and difficult to manage. I thought you might find this resource useful: https://migraine.com/living-migraine/cgrp-cluster-headache-different
          Warmly, Holly (migraine.com team).

        2. AWESOME. That's fantastic news, and a testament of your hard work in advocating for yourself! I'm proud of you, truly. My fingers are firmly crossed and I'll say a little prayer it's a great fit.

          If you're curious, our very own was gracious enough to put a demo video together of how to use Emgality a while back. It can be so helpful to see another person do it. Here's the link if you want to take a look:

          https://migraine.com/video/emgality-self-injector

          Hope that's useful. Best wishes to you!! -Melissa, migraine.com team


      2. Update! I went to see my doctor yesterday. Just my regular doc. I brought highlighted printouts and everything (that’s just how I roll ha ha!) He put his finger down on Emigality, smiled at me and said, “We have samples!” I love this man! Turns out it is covered by Medicaid with pre-authorization, so we left the sample for someone who may not be covered. I’ll be picking it up as soon as the paperwork goes through! Fingers crossed!

        1. It seems there is a wide range of various responses to the ways these CGRPs work on different people. I'm not sure I've heard of 6 months- I have heard between 1-3 months. I've also heard under a week. Here's a forum we have dedicated to people sharing their experiences with Emgality which you may find helpful, but do keep in mind that everyone is different: https://migraine.com/forums/emgality-share-experience
          Please let us know if you have any other questions. Warmly, Holly (migraine.com team).

        2. I responded to you yesterday but it showed up in a weird spot a few posts up from here. Hopefully you saw it. Proud of you! -Melissa, migraine.com team

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