Does Gateway Health Plan Cover Emgality

Learn if Gateway Health Plan covers Emgality, reasons for denial, coverage steps, costs without insurance, and get answers to common Emgality questions.
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“Curex is changing the landscape of allergies in 2024”
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Coverage for Emgality

 

  • Gateway Health Plan may cover Emgality for patients diagnosed with chronic migraine or cluster headaches.
  •  

  • Coverage is often subject to the plan's specific terms, requiring prior authorization.
  •  

  • Patients might need documentation proving that other migraine treatments were not effective.

 

Basic Rules & Criteria

 

  • The patient must be enrolled in a Gateway Health Plan policy that includes prescription drug coverage.
  •  

  • Proof of medical necessity from a healthcare provider usually needs to be provided to qualify for coverage.
  •  

  • Pharmacy benefit management services may specify preferred medications; Emgality could be listed as a preferred option or require a step therapy process.
  •  

  • Check with Gateway Health Plan customer service for detailed eligibility criteria and authorization processes.

 

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Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Emgality Coverage with Gateway Health Plan

 

Determine Emgality Coverage Eligibility

 

  • Contact Gateway Health Plan to verify if Emgality (a medication for migraine prevention) is covered under your current plan.
  •  

  • Review your specific plan details, as coverage may vary based on your policy type or health conditions.
  •  

  • Ensure you meet any necessary criteria for coverage, such as having a diagnosis confirmed by a healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor or specialist whether Emgality is a suitable treatment option for you.
  •  

  • Request that your healthcare provider writes a prescription for Emgality, noting any supporting information that may help with coverage justification.

 

Complete Prior Authorization if Required

 

  • Check if Gateway Health Plan requires prior authorization for Emgality to be covered under your plan.
  •  

  • If needed, work with your healthcare provider to complete and submit a prior authorization form, providing necessary medical documentation.

 

Submit Necessary Documentation

 

  • Gather all required documents, such as medical records, a copy of the prescription, and any additional supporting information.
  •  

  • Submit these documents to Gateway Health Plan through their designated submission process, either online, by mail, or through your healthcare provider.

 

Monitor Application Status and Follow Up

 

  • Regularly check with Gateway Health Plan regarding the status of your Emgality coverage application.
  •  

  • If additional information or clarification is needed, promptly provide the requested details to avoid delays.
  •  

  • Maintain communication with both your healthcare provider and insurance plan until coverage approval is confirmed.

 

Appeal if Coverage Is Denied

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reasons behind the decision.
  •  

  • Prepare to file an appeal by gathering any additional documentation or evidence that supports the necessity of Emgality for your treatment.
  •  

  • Submit the appeal according to Gateway Health Plan's guidelines, ensuring all forms and documents are completed accurately.

 

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Does Gateway Health Plan Cover Emgality

Learn if Gateway Health Plan covers Emgality, reasons for denial, coverage steps, costs without insurance, and get answers to common Emgality questions.
Curex allergy drops unboxing

Is Emgality Covered by Gateway Health Plan

 

Coverage for Emgality

 

  • Gateway Health Plan may cover Emgality for patients diagnosed with chronic migraine or cluster headaches.
  •  

  • Coverage is often subject to the plan's specific terms, requiring prior authorization.
  •  

  • Patients might need documentation proving that other migraine treatments were not effective.

 

Basic Rules & Criteria

 

  • The patient must be enrolled in a Gateway Health Plan policy that includes prescription drug coverage.
  •  

  • Proof of medical necessity from a healthcare provider usually needs to be provided to qualify for coverage.
  •  

  • Pharmacy benefit management services may specify preferred medications; Emgality could be listed as a preferred option or require a step therapy process.
  •  

  • Check with Gateway Health Plan customer service for detailed eligibility criteria and authorization processes.

 

A weight management program tailored to you

Start with Curex

Gateway Health Plan's Approved Criteria for Emgality Coverage

 

Emgality Coverage Criteria

 

  • **Diagnosis Requirement**: The patient must have a confirmed diagnosis of either episodic or chronic migraine, validated by a healthcare provider.
  •  

  • **Age Criteria**: Coverage is available for patients 18 years of age or older.
  •  

  • **Medical History**: The patient should have a documented history of at least 4 migraine days per month before starting Emgality.
  •  

  • **Previous Treatments**: Patients must have tried and had an inadequate response, intolerance, or contraindication to at least two other preventive migraine headache treatments from different pharmacologic classes.
  •  

  • **Prescribing Provider**: The prescription for Emgality must be written by a neurologist, headache specialist, or another qualified healthcare professional experienced in the management of migraine.
  •  

  • **Dosage and Administration**: The requested dosage must align with the FDA-approved dosage recommendations, typically 240 mg loading dose followed by 120 mg monthly.
  •  

  • **Documentation Requirements**: The patient's medical records must document all the necessary criteria, including diagnosis, previous medication trials, and the prescribing provider's details.
  •  

  • **Continued Coverage Eligibility**: For continued coverage, patients must demonstrate a reduction in the frequency of migraine attacks, which can be measured as at least a 50% reduction in migraine days, and medical records need to be updated indicating such improvement.
    •  

Why Gateway Health Plan Might Deny Emgality Coverage

 

Criteria for Denying Emgality Coverage by Gateway Health Plan

 

  • Emgality is excluded from the formulary for the patient's specific plan. This means that the medication is not listed as a covered drug under the patient's particular health insurance plan, and exceptions are not applicable unless other criteria are met.
  •  

  • The condition being treated is not covered under the plan. If a patient is seeking Emgality for an off-label use that is not approved by the plan, coverage may be denied.
  •  

  • Prior authorization is not obtained or denied. Many insurance plans require prior authorization for medications like Emgality. If this process is not completed successfully, coverage will not be extended.
  •  

  • Failure to meet clinical criteria. Specific clinical criteria may need to be fulfilled for coverage; if the patient does not meet these, Emgality may be denied.
  •  

  • Prescription from an out-of-network provider. If Emgality is not prescribed by a preferred or in-network provider, Gateway Health Plan might deny coverage.
  •  

  • Non-compliance with step therapy protocols. If the insurance plan requires trying alternative treatments first, failure to do so can result in denial of Emgality.
  •  

  • Lapse in premium payment or active insurance coverage. If a patient’s insurance plan is not active due to non-payment or other factors, medication coverage, including Emgality, will not be provided.

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Emgality Cost without Insurance?

 

Approximate Cost of Emgality Without Insurance

 

  • The price of Emgality (galcanezumab-gnlm) for an individual who is paying out-of-pocket can vary widely. On average, the cost for a one-month supply of Emgality, which is typically one syringe or auto-injector, is approximately $600 to $700.
  •  

  • Prices may differ based on the pharmacy and location. It's advisable to compare prices from different pharmacies, as there can be significant variation.
  •  

  • Many pharmaceutical companies, including the makers of Emgality, offer savings programs or patient assistance options for those who might struggle with the full cost of the medication. These programs can sometimes significantly reduce the out-of-pocket expenses for eligible patients.
  •  

  • In addition, discount cards or coupons from third-party services might be available that can reduce the retail price. However, always verify the legitimacy and terms of such offers.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Emgality Coverage with Gateway Health Plan

 

Determine Emgality Coverage Eligibility

 

  • Contact Gateway Health Plan to verify if Emgality (a medication for migraine prevention) is covered under your current plan.
  •  

  • Review your specific plan details, as coverage may vary based on your policy type or health conditions.
  •  

  • Ensure you meet any necessary criteria for coverage, such as having a diagnosis confirmed by a healthcare provider.

 

Consult with Your Healthcare Provider

 

  • Discuss with your doctor or specialist whether Emgality is a suitable treatment option for you.
  •  

  • Request that your healthcare provider writes a prescription for Emgality, noting any supporting information that may help with coverage justification.

 

Complete Prior Authorization if Required

 

  • Check if Gateway Health Plan requires prior authorization for Emgality to be covered under your plan.
  •  

  • If needed, work with your healthcare provider to complete and submit a prior authorization form, providing necessary medical documentation.

 

Submit Necessary Documentation

 

  • Gather all required documents, such as medical records, a copy of the prescription, and any additional supporting information.
  •  

  • Submit these documents to Gateway Health Plan through their designated submission process, either online, by mail, or through your healthcare provider.

 

Monitor Application Status and Follow Up

 

  • Regularly check with Gateway Health Plan regarding the status of your Emgality coverage application.
  •  

  • If additional information or clarification is needed, promptly provide the requested details to avoid delays.
  •  

  • Maintain communication with both your healthcare provider and insurance plan until coverage approval is confirmed.

 

Appeal if Coverage Is Denied

 

  • If your request for coverage is denied, review the denial letter carefully to understand the reasons behind the decision.
  •  

  • Prepare to file an appeal by gathering any additional documentation or evidence that supports the necessity of Emgality for your treatment.
  •  

  • Submit the appeal according to Gateway Health Plan's guidelines, ensuring all forms and documents are completed accurately.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Emgality FAQ

1. What are the common side effects of Emgality?

 

Common Side Effects of Emgality

 

  • Injection site reactions: including pain, redness, and itching at the injection site.
  •  

  • Constipation: a relatively frequent digestive side effect experienced by some patients.
  •  

  • Hypersensitivity reactions: such as rash, itching, or swelling in some individuals.
  •  

  • Respiratory effects: includes symptoms like cough or shortness of breath.
  •  

  • Fatigue: feelings of tiredness or lethargy reported by a number of users.
  •  

  • Difficulty sleeping: some patients may experience insomnia or sleep disturbances.

 

Consult Healthcare Provider

 

  • If side effects are severe or persistent, it is crucial to consult with a healthcare provider.

 

2. How long does it take for Emgality to start working?

 

How Emgality Works

 

  • Emgality is a monoclonal antibody that targets CGRP, a protein linked to migraine.
  •  

  • It's used for migraine prevention and treatment of cluster headaches.

 

Timeline for Effectiveness

 

  • Some patients report migraine reduction within 1 week of initial injection.
  •  

  • Maximum benefits typically observed after 2-3 months of consistent use.
  •  

  • Individual response varies; some might experience quicker relief than others.

 

Factors Influencing Effectiveness

 

  • Variability in individual biology and metabolism affects onset of relief.
  •  

  • Concurrent medications and overall health may also play a role.

 

Considerations

 

  • Consult with your healthcare provider for tailored advice based on your health profile.
  •  

  • Be consistent with your dosing schedule for optimal results.

 

3. Can Emgality be used for both prevention and treatment of migraines?

 

Usage of Emgality

 

  • Emgality is primarily approved for use as a preventive treatment for migraine. It is designed to reduce the frequency of migraine headaches in adults.
  •  

  • Emgality works by targeting and blocking the calcitonin gene-related peptide (CGRP), a molecule involved in migraine attacks.

 

Not for Acute Treatment

 

  • Emgality is not used for the acute treatment of migraine attacks once they've started. Other medications are typically prescribed for immediate relief.
  •  

  • Consult a healthcare provider for recommendations on acute migraine management options.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does Gateway Health Plan Cover Emgality

Learn if Gateway Health Plan covers Emgality, reasons for denial, coverage steps, costs without insurance, and get answers to common Emgality questions.
Curex allergy drops unboxing

Does Gateway Health Plan Cover Emgality

 

Coverage for Emgality

 

  • Gateway Health Plan may cover Emgality for patients diagnosed with chronic migraine or cluster headaches.
  •  

  • Coverage is often subject to the plan's specific terms, requiring prior authorization.
  •  

  • Patients might need documentation proving that other migraine treatments were not effective.

 

Basic Rules & Criteria

 

  • The patient must be enrolled in a Gateway Health Plan policy that includes prescription drug coverage.
  •  

  • Proof of medical necessity from a healthcare provider usually needs to be provided to qualify for coverage.
  •  

  • Pharmacy benefit management services may specify preferred medications; Emgality could be listed as a preferred option or require a step therapy process.
  •  

  • Check with Gateway Health Plan customer service for detailed eligibility criteria and authorization processes.

 

A weight management program tailored to you

Start with Curex

Why Gateway Health Plan Might Deny Emgality Coverage

 

Emgality Coverage Criteria

 

  • **Diagnosis Requirement**: The patient must have a confirmed diagnosis of either episodic or chronic migraine, validated by a healthcare provider.
  •  

  • **Age Criteria**: Coverage is available for patients 18 years of age or older.
  •  

  • **Medical History**: The patient should have a documented history of at least 4 migraine days per month before starting Emgality.
  •  

  • **Previous Treatments**: Patients must have tried and had an inadequate response, intolerance, or contraindication to at least two other preventive migraine headache treatments from different pharmacologic classes.
  •  

  • **Prescribing Provider**: The prescription for Emgality must be written by a neurologist, headache specialist, or another qualified healthcare professional experienced in the management of migraine.
  •  

  • **Dosage and Administration**: The requested dosage must align with the FDA-approved dosage recommendations, typically 240 mg loading dose followed by 120 mg monthly.
  •  

  • **Documentation Requirements**: The patient's medical records must document all the necessary criteria, including diagnosis, previous medication trials, and the prescribing provider's details.
  •  

  • **Continued Coverage Eligibility**: For continued coverage, patients must demonstrate a reduction in the frequency of migraine attacks, which can be measured as at least a 50% reduction in migraine days, and medical records need to be updated indicating such improvement.
    •  

Together with our partners we have changed the lives of over 300,000 patients.

Emgality FAQ

 

Criteria for Denying Emgality Coverage by Gateway Health Plan

 

  • Emgality is excluded from the formulary for the patient's specific plan. This means that the medication is not listed as a covered drug under the patient's particular health insurance plan, and exceptions are not applicable unless other criteria are met.
  •  

  • The condition being treated is not covered under the plan. If a patient is seeking Emgality for an off-label use that is not approved by the plan, coverage may be denied.
  •  

  • Prior authorization is not obtained or denied. Many insurance plans require prior authorization for medications like Emgality. If this process is not completed successfully, coverage will not be extended.
  •  

  • Failure to meet clinical criteria. Specific clinical criteria may need to be fulfilled for coverage; if the patient does not meet these, Emgality may be denied.
  •  

  • Prescription from an out-of-network provider. If Emgality is not prescribed by a preferred or in-network provider, Gateway Health Plan might deny coverage.
  •  

  • Non-compliance with step therapy protocols. If the insurance plan requires trying alternative treatments first, failure to do so can result in denial of Emgality.
  •  

  • Lapse in premium payment or active insurance coverage. If a patient’s insurance plan is not active due to non-payment or other factors, medication coverage, including Emgality, will not be provided.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How Much Does Emgality Cost without Insurance?

 

Approximate Cost of Emgality Without Insurance

 

  • The price of Emgality (galcanezumab-gnlm) for an individual who is paying out-of-pocket can vary widely. On average, the cost for a one-month supply of Emgality, which is typically one syringe or auto-injector, is approximately $600 to $700.
  •  

  • Prices may differ based on the pharmacy and location. It's advisable to compare prices from different pharmacies, as there can be significant variation.
  •  

  • Many pharmaceutical companies, including the makers of Emgality, offer savings programs or patient assistance options for those who might struggle with the full cost of the medication. These programs can sometimes significantly reduce the out-of-pocket expenses for eligible patients.
  •  

  • In addition, discount cards or coupons from third-party services might be available that can reduce the retail price. However, always verify the legitimacy and terms of such offers.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.