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Newer Meds Like Nurtec on Medicare


In 2 months, I will go on Medicare. I have done extensive research on every Part D Supplement that I am eligible for (even the most expensive ones) and I cannot find any that cover a medication like Nurtec, which has been highly recommended to me.

Let me also say that I've had very little success with the Triptans and I'm currently using Topirimate, which I am also having very little success with.

When I price Nurtec with all of the Part D plans I am eligible for, it comes to $6000/year out of pocket with absolutely no coverage from Medicare or the insurance company. Furthermore, when I contact the manufacturer, their subsidy and coupon programs explicitly prohibit their usage if one is on Medicare.

I did try Emgality a couple of years ago under private insurance, but it also didn't help very much. Emgality under Medicare is also costly, but at least it is covered and the out of pocket expense is about half that of Nurtec or less.

I've also tried online pharmacies like GoodRx and Canadian Pharmacies and while they can shave off a few hundred dollars per year, the annual out of pocket costs are still over $5000.

Has anyone under Medicare managed to find a way to get better coverage for Nurtec?

  1. I hear you and understand how frustrating this is, I'm in the same boat. I wish I had an answer for you. My doctor has given me samples, maybe that's a route to take? Hopefully others will be in shortly to share their experiences with you.
    Please keep us posted, Nancy Harris Bonk, Patient Advocate/Moderator

    1. Every situation is different. I also think when you look at it like that, it doesn't take into account prior authorizations. I could be wrong, but I know Nurtec isn't on my formulary for Medicare and I've had no problem accessing it. Each plan is different and if it's approved but the tier is too high, you can appeal that to reduce the tier. GoodRX and those aren't going to have anything different because it's a new to market medication. Have you been working with a navigator who looks at all the plans and your doctors and medications? I don't know if they can see the prior authorization information or can give you a number to call to ask more detailed information. Biohaven's patient assistance program (which is for those who don't have commericial insurance) is one of the worst. If your drug plan denies it 3 times, they will provide it for free. If they approve it, but it's at the high tier where it's unaffordable, they don't help. my doctor doesn't have samples, of anything. But as you get to that, have your dr office ready to do prior authorizations and all that, be ready to advocate but hopefully it will go smoothly for you.

      1. I'm on their website right now. Go to their page where they talk about savings, scroll down to where you see "Don't have Health Insurance" and click that link. Like I said, it's one of the hardest patient assistance programs to navigate because your insurance company has to deny it flat out before you can qualify. But, if you get an insurance that won't cover it, it will help you. A friend of mine was a part of the program because her Medicare didn't cover it.

      2. I know what you're referring to. But I can only tell you that when I called, they told me it doesn't apply to Medicare. And even if it did, do you realize what 3X the Federal poverty level is in terms of income?

    2. - I'm glad you asked about this. I wrote an article about this very topic just recently which I think may prove helpful- yet it probably primarily will prove your research right. Please do have a look (as well as the comments that follow it as community members offer their input and ideas/experiences there):
      Also, here is another piece in which the comment section of the article touches on this topic - it was just posted last week- and you'll see that this question arises there too:
      Hope these are helpful. You are certainly (unfortunately) not alone in this challenge.
      We are here for you. - Holly (team member)

      1. ho online and type in either one and look for grants. You do have to check a lot for them. I had one for Prolia but it ended.

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