$49$0.99

Does MDwise Cover Emgality

Explore Emgality coverage by MDwise, reasons for denial, tips for approval, cost without insurance, and common questions answered.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

Emgality Coverage by MDwise

MDwise covers Emgality for eligible members primarily to treat migraine and cluster headaches. The coverage is contingent upon specific medical necessity criteria.

Patients usually must have a diagnosis of chronic or episodic migraines as confirmed by a healthcare provider to qualify for coverage.

Criteria and Procedures

A healthcare provider may need to demonstrate that other migraine treatments were ineffective or contraindicated, often necessitating documentation.

Pre-authorization is typically required before commencing treatment, ensuring that all MDwise guidelines and criteria are met.

Patients might need to present a detailed medical history supporting the diagnosis and necessity for Emgality.

Basic Rules

Coverage generally applies only when prescriptions are filled through in-network pharmacies, unless specified otherwise by MDwise.

MDwise plan members should consult the specific terms of their plan, as coverage terms may vary and certain restrictions or additional costs might apply.

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49 $9.99

Review your allergy test results with a Curex allergist.

Start Now

Clinical Support

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 MDwise

Verify Your Eligibility

Contact MDwise customer service to confirm that Emgality is covered under your specific health plan.
Check if there are any prerequisites or restrictions, such as step therapy or prior authorization, required to obtain coverage for Emgality.
Ensure your healthcare provider is within the MDwise network to facilitate smoother processing of your claims.

Consult with Your Healthcare Provider

Schedule an appointment with your doctor to discuss your need for Emgality and ensure it is the right treatment for you.
Ask your healthcare provider to write a prescription for Emgality, specifically noting any medical necessity to help with insurance approval.
Discuss with your doctor the potential for them to submit any required documentation directly to MDwise on your behalf.

Submit a Prior Authorization Request

If a prior authorization is required, work with your healthcare provider to complete the necessary forms.
Submit the prior authorization request form to MDwise along with any supporting documentation, such as your doctor's notes or medical history.
Contact MDwise to confirm receipt of the prior authorization request and inquire about the timeline for a decision.

Contact MDwise Member Services

Reach out to MDwise’s member services department for any clarifications about the steps needed to gain coverage for Emgality.
Ask for any additional documentation or forms that need to be completed for the coverage request.
Inquire about any potential financial assistance programs available for Emgality through MDwise.

Follow Up and Navigate Appeals

Keep track of the status of your prior authorization and follow up regularly with both MDwise and your healthcare provider.
If the coverage is denied, request information on the reason for denial and understand the appeals process.
Work with your doctor to provide additional necessary medical documentation to support your appeal if needed.

Fill Your Prescription

Once approval is obtained, take your Emgality prescription to a pharmacy that accepts MDwise coverage to fill the prescription.
Ensure that you understand your copayment or any out-of-pocket costs associated with obtaining Emgality.
Verify that the pharmacy has billed MDwise correctly to avoid unexpected expenses.

Happy Customers

We love helping people!

Allie, Nevada

"I have two cats I can finally cuddle!"
‍

Cat and dog allergies

Zachary, Texas

“I can breathe through my nose for the first time in like 20 years!"

Dust and mold allergies

Erika, New York

“I've noticed less sneezing and shortness of breath.”

Tree and grass allergies

Richard, Texas

I love the convenience!
‍

Tree and cat allergies

We Treat Allergies

Food Allergies

Weed Pollens

Cat Allergies

Dog Allergies

Dust Mites

Molds

Tree Pollens

curex user showing allergy treatment kit

a male patient showing allergy drops vial

50,000+ users have overcome their allergies

Am I eligible?

At-home Immunotherapy

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option

Treatment prescribed
by clinician

Clinicaly made allergen extracts are customized for your allergies

Your immune system gets desensitized to allergens, giving you long-term relief.

FAQs

Does MDwise Cover Emgality

Explore Emgality coverage by MDwise, reasons for denial, tips for approval, cost without insurance, and common questions answered.

Achieve Your Goals Faster with Curex

Is Emgality Covered by MDwise

Emgality Coverage by MDwise

MDwise covers Emgality for eligible members primarily to treat migraine and cluster headaches. The coverage is contingent upon specific medical necessity criteria.

Patients usually must have a diagnosis of chronic or episodic migraines as confirmed by a healthcare provider to qualify for coverage.

Criteria and Procedures

A healthcare provider may need to demonstrate that other migraine treatments were ineffective or contraindicated, often necessitating documentation.

Pre-authorization is typically required before commencing treatment, ensuring that all MDwise guidelines and criteria are met.

Patients might need to present a detailed medical history supporting the diagnosis and necessity for Emgality.

Basic Rules

Coverage generally applies only when prescriptions are filled through in-network pharmacies, unless specified otherwise by MDwise.

MDwise plan members should consult the specific terms of their plan, as coverage terms may vary and certain restrictions or additional costs might apply.

A weight management program tailored to you

Start with Curex

MDwise's Approved Criteria for Emgality Coverage

Eligibility Criteria for Emgality Coverage

Diagnosis of migraine, confirmed by a healthcare provider who specializes in headache treatment.

Patient is 18 years of age or older.

Previous trial and failure, contraindication, or intolerance to at least two other medications used for migraine prevention, such as beta blockers or antiepileptic drugs.

Treatment Guidelines

Emgality is prescribed in accordance with FDA-approved dosing recommendations for the prevention of migraines.

Documentation of patient monitoring by a healthcare provider to assess effectiveness and manage potential adverse effects.

Authorization and Approval Process

Initial coverage authorization may require submission of clinical documentation supporting the diagnosis and previous treatment attempts.

Re-evaluation of prescription coverage may be conducted annually to ensure continued medical necessity and effectiveness.

Why MDwise Might Deny Emgality Coverage

Reasons MDwise May Deny Emgality Coverage

**Non-Formulary Medication**: If Emgality is not listed on the MDwise formulary, coverage may be denied.

**Lack of Medical Necessity**: Coverage might be denied if there is insufficient evidence to demonstrate the medical necessity of Emgality for the individual's condition.

**Failure to Meet Diagnostic Criteria**: If the patient's condition does not meet the specific diagnostic criteria set forth by MDwise for Emgality coverage, the claim may be denied.

**Prior Authorization Not Obtained**: Failure to obtain prior authorization from MDwise before starting Emgality can result in a denial of coverage.

**Policy Exclusions**: Emgality may not be covered if it falls under specific exclusions within the individual's MDwise insurance policy.

**Usage Outside Approved Indications**: MDwise may deny coverage if Emgality is used for conditions or ways that are not approved or accepted.

**Experimental or Investigational Use**: If Emgality is considered experimental or investigational for a particular use, MDwise may not cover it.

**Patient Age Restrictions**: Coverage may be denied based on age restrictions, if applicable under the policy guidelines.

**Non-Compliant with Step Therapy Requirements**: If step therapy requirements have not been followed as per MDwise policy, coverage may be denied.

**Out of Network Prescriber**: If Emgality is prescribed by a healthcare provider who is outside the MDwise network, coverage might be denied.

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

Join Curex

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.

Clinical Support

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

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

Kayla Mardaga, NP

How to Get Emgality Coverage with MDwise

Verify Your Eligibility

Contact MDwise customer service to confirm that Emgality is covered under your specific health plan.
Check if there are any prerequisites or restrictions, such as step therapy or prior authorization, required to obtain coverage for Emgality.
Ensure your healthcare provider is within the MDwise network to facilitate smoother processing of your claims.

Consult with Your Healthcare Provider

Schedule an appointment with your doctor to discuss your need for Emgality and ensure it is the right treatment for you.
Ask your healthcare provider to write a prescription for Emgality, specifically noting any medical necessity to help with insurance approval.
Discuss with your doctor the potential for them to submit any required documentation directly to MDwise on your behalf.

Submit a Prior Authorization Request

If a prior authorization is required, work with your healthcare provider to complete the necessary forms.
Submit the prior authorization request form to MDwise along with any supporting documentation, such as your doctor's notes or medical history.
Contact MDwise to confirm receipt of the prior authorization request and inquire about the timeline for a decision.

Contact MDwise Member Services

Reach out to MDwise’s member services department for any clarifications about the steps needed to gain coverage for Emgality.
Ask for any additional documentation or forms that need to be completed for the coverage request.
Inquire about any potential financial assistance programs available for Emgality through MDwise.

Follow Up and Navigate Appeals

Keep track of the status of your prior authorization and follow up regularly with both MDwise and your healthcare provider.
If the coverage is denied, request information on the reason for denial and understand the appeals process.
Work with your doctor to provide additional necessary medical documentation to support your appeal if needed.

Fill Your Prescription

Once approval is obtained, take your Emgality prescription to a pharmacy that accepts MDwise coverage to fill the prescription.
Ensure that you understand your copayment or any out-of-pocket costs associated with obtaining Emgality.
Verify that the pharmacy has billed MDwise correctly to avoid unexpected expenses.

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

Learn More

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

Button Text

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 MDwise Cover Emgality

Explore Emgality coverage by MDwise, reasons for denial, tips for approval, cost without insurance, and common questions answered.

Achieve Your Goals Faster with Curex