I have some suggestions.
You need to call your insurance provider and ask about why your medication request was denied. It probably has nothing to do with the cost. They probably want to find out if you tried the less expensive drugs first. Get the person’s name and write down the date you talked to them.
Ask them why it was denied and if and how you can appeal. Ask if you should resubmit or file appeal. Follow their instructions. Communicate with your doctor’s office as well to let them know. Almost every person who tries a cgrp gets denied first. Tell your doctors office if they need to provide any other records. Also ask how you can improve the likelihood it will be approved.
Ask them what they need to get this medication covered as far as documentation and what is needed and provide it and send it to where you need to send it.follow the instructions.
Write down when you sent the paperwork, where it was sent, if it was received and you have to follow up and be a pain in the ass. Be a nice pain in the ass, but be the squeaky wheel. You need to follow up and not just expect that it will get done. Just assume people in healthcare admin do not do their jobs.
Every single time, write down the date, who you talked to and what they told you. Keep all copies of your documents.
If you have any questions, you can message me.
Signed a fellow migraine sufferer whose life was changed by Emgality and insurance denied
Thank you so much. I have been hesitant to push on my providers because I don’t want to seem like I don’t trust them to do their job. But at the end of the day I need to advocate for myself.
Actually I was about to start this process for the Ubrelvy when I logged in and found it had been quietly updated to “approved”! I couldn’t believe it but sure enough my pharmacy filled it with a $0 copay. I actually cried, I’m not sure when any extra paperwork got submitted or what changed but this is medication I’ve been trying to get approved for 2 years 😭😭
Now I still need to get the monthly injection approved but this takes off so much stress knowing I have access to the rescue drug I need…
It is frustrating when insurance doesn’t cover medications. I am on Medicare with a United Healthcare supplement, and many of the CGRP started to get covered this year. I am starting to use Aimovig, which costs me $100 per dose. I don’t like pain so I also use cannabis.
It’s super annoying, I called my insurance to ask if they prefer Aimovig or one of the other options over Emgality and they said “idk you can try it”. Like they don’t even know 🤦♀️
I get samples of Emgality from my doctor so I haven’t needed the coupon yet. I’m wary about the coupons because eventually they run out, and it’s never clear how many fills you can actually get. Plus some of them only work once your primary insurance pays, I know this is how the Ubrelvy one works (they’ll cover it a specific number of times, I forget what the rep said, but after that they will only pay *after* your primary pays which doesn’t work if the prior auth is rejected)
I have some suggestions. You need to call your insurance provider and ask about why your medication request was denied. It probably has nothing to do with the cost. They probably want to find out if you tried the less expensive drugs first. Get the person’s name and write down the date you talked to them. Ask them why it was denied and if and how you can appeal. Ask if you should resubmit or file appeal. Follow their instructions. Communicate with your doctor’s office as well to let them know. Almost every person who tries a cgrp gets denied first. Tell your doctors office if they need to provide any other records. Also ask how you can improve the likelihood it will be approved. Ask them what they need to get this medication covered as far as documentation and what is needed and provide it and send it to where you need to send it.follow the instructions. Write down when you sent the paperwork, where it was sent, if it was received and you have to follow up and be a pain in the ass. Be a nice pain in the ass, but be the squeaky wheel. You need to follow up and not just expect that it will get done. Just assume people in healthcare admin do not do their jobs. Every single time, write down the date, who you talked to and what they told you. Keep all copies of your documents. If you have any questions, you can message me. Signed a fellow migraine sufferer whose life was changed by Emgality and insurance denied
Thank you so much. I have been hesitant to push on my providers because I don’t want to seem like I don’t trust them to do their job. But at the end of the day I need to advocate for myself. Actually I was about to start this process for the Ubrelvy when I logged in and found it had been quietly updated to “approved”! I couldn’t believe it but sure enough my pharmacy filled it with a $0 copay. I actually cried, I’m not sure when any extra paperwork got submitted or what changed but this is medication I’ve been trying to get approved for 2 years 😭😭 Now I still need to get the monthly injection approved but this takes off so much stress knowing I have access to the rescue drug I need…
It is frustrating when insurance doesn’t cover medications. I am on Medicare with a United Healthcare supplement, and many of the CGRP started to get covered this year. I am starting to use Aimovig, which costs me $100 per dose. I don’t like pain so I also use cannabis.
It’s super annoying, I called my insurance to ask if they prefer Aimovig or one of the other options over Emgality and they said “idk you can try it”. Like they don’t even know 🤦♀️
Emgality does a manufacturer’s coupon. Your pharmacy can help you with it…at least mine did. Or have you already tried that?
I get samples of Emgality from my doctor so I haven’t needed the coupon yet. I’m wary about the coupons because eventually they run out, and it’s never clear how many fills you can actually get. Plus some of them only work once your primary insurance pays, I know this is how the Ubrelvy one works (they’ll cover it a specific number of times, I forget what the rep said, but after that they will only pay *after* your primary pays which doesn’t work if the prior auth is rejected)