$49$0.99

Does UPMC Health Plan Cover Emgality

Explore Emgality coverage with UPMC Health Plan: potential denials, securing coverage, costs without insurance, and FAQs. Learn what to expect.

Treat your allergies with Curex

as seen on

“Curex is changing the landscape of allergies in 2024”

UPMC Health Plan Coverage for Emgality

UPMC Health Plan generally covers Emgality for patients diagnosed with chronic migraine or episodic cluster headache. Coverage depends on meeting certain medical necessity criteria.

Prescribers often need to document previous treatments that have been tried and failed, or were not tolerated, to justify the use of Emgality.

Patients may require prior authorization, which involves approval from UPMC to confirm the drug is medically necessary based on the patient's condition and history.

Coverage policies can vary, and individuals should consult plan details or contact UPMC Health Plan directly for specific coverage requirements.

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 UPMC Health Plan

Verify Your Policy

Contact UPMC Health Plan customer service to understand what your current policy covers. Ask specifically about coverage for Emgality.

Review your benefits document or the UPMC Health Plan member portal to check for any mention of Emgality coverage and any steps required to obtain it.

Consult with Your Healthcare Provider

Schedule a consultation with your doctor to discuss the need for Emgality in your treatment plan. Explain any migraine issues or other conditions you are experiencing.

Request your healthcare provider to write a prescription for Emgality and to provide any necessary medical documentation that the health plan may require.

Verify Formulary Inclusion

Check the UPMC Health Plan formulary list online or contact customer service to confirm that Emgality is included. This is essential, as not all medications are automatically covered.

If Emgality is not listed, discuss with your healthcare provider about alternatives or the potential for obtaining an exception.

Complete Prior Authorization (If Required)

Your healthcare provider may need to submit a prior authorization request to UPMC Health Plan. This involves providing detailed information on why Emgality is necessary for your treatment.

Ensure that all forms and accompanying documents are filled out correctly and submitted promptly to avoid unnecessary delays.

Understand Coverage Terms

Ask UPMC Health Plan about any copayments, coinsurance, or deductibles you may need to cover when obtaining Emgality.

Inquire if there are any quantity limits, refill rules, or specific pharmacies where your prescription must be filled.

Monitor Your Claims

After receiving Emgality, keep track of your claims to ensure the coverage applies correctly. You can do this through the member portal or regular statements.

Contact customer service immediately if any discrepancies are found in the claims regarding Emgality coverage.

File an Appeal (If Necessary)

If your request for coverage is denied, UPMC Health Plan should provide a reason. File an appeal by submitting the necessary forms and additional documentation supporting your need for Emgality.

Work closely with your doctor during the appeal process to gather all necessary medical evidence and ensure a compelling case.

Follow Up Regularly

Maintain regular contact with both UPMC Health Plan and your healthcare provider to track the progress of your coverage request or appeal.

Update any information as needed and respond swiftly to any requests from UPMC Health Plan to prevent delays in obtaining your medication.

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 UPMC Health Plan Cover Emgality

Explore Emgality coverage with UPMC Health Plan: potential denials, securing coverage, costs without insurance, and FAQs. Learn what to expect.

Achieve Your Goals Faster with Curex

Is Emgality Covered by UPMC Health Plan

UPMC Health Plan Coverage for Emgality

UPMC Health Plan generally covers Emgality for patients diagnosed with chronic migraine or episodic cluster headache. Coverage depends on meeting certain medical necessity criteria.

Prescribers often need to document previous treatments that have been tried and failed, or were not tolerated, to justify the use of Emgality.

Patients may require prior authorization, which involves approval from UPMC to confirm the drug is medically necessary based on the patient's condition and history.

Coverage policies can vary, and individuals should consult plan details or contact UPMC Health Plan directly for specific coverage requirements.

A weight management program tailored to you

Start with Curex

UPMC Health Plan's Approved Criteria for Emgality Coverage

Criteria for Emgality Coverage

The member must have a diagnosis of chronic migraine, defined as headaches occurring on 15 or more days per month for more than three months, and must have a history of migraine for at least six months prior to the approval request.

Emgality must be prescribed by, or in consultation with, a neurologist or a headache specialist.

The member must have tried and failed at least two different classes of prophylactic migraine medications, unless contraindicated or otherwise clinically inappropriate. Examples include beta-blockers, anticonvulsants, antidepressants, or other CGRP inhibitors.

There must be documented evidence of the member experiencing a significant reduction in the number of migraine days per month with previous similar treatments, warranting the validation for Emgality adjustments and effectiveness.

The prescribed dose must not exceed 120 mg once monthly following an initial loading dose of 240 mg per the manufacturer's guidelines.

Language in the approval request must clarify the absence of other medication therapies potentially contributing to migraine, such as overuse of acute migraine-specific medications.

A trial assessment for at least three months is required to establish effectiveness in decreasing the frequency or severity of migraine episodes.

Continued Use Criteria

Renewal requests must show documented evidence of a sustained positive response to Emgality, demonstrated by a decrease in monthly migraine days.

The treating physician must confirm an ongoing treatment regimen, with review and adjustment of alternative oral therapies every six months alongside Emgality to ensure optimal care.

There should be no significant adverse effects directly attributed to Emgality use that outweigh clinical benefits in the prevention of migraine.

Why UPMC Health Plan Might Deny Emgality Coverage

Situations When UPMC Health Plan Might Deny Emgality Coverage

**Non-Approved Diagnoses:** UPMC Health Plan may deny Emgality coverage if the medication is prescribed for a condition not approved by the US FDA or outside the plan's listed diagnostic criteria.

**Lack of Prior Authorization:** If prior authorization has not been obtained, UPMC may refuse to cover Emgality. This involves a healthcare provider not submitting the necessary documentation or failing to demonstrate medical necessity.

**Failure to Meet Step Therapy Requirements:** UPMC Health Plan could reject coverage if the patient has not tried and failed other preferred therapies or medications specified in their step therapy guidelines before authorizing Emgality.

**Out-of-Network Providers:** Coverage might be denied if Emgality is prescribed by or obtained from an out-of-network provider, unless prior approval for an exception has been provided by UPMC.

**Incomplete Documentation:** Claims may be denied if the necessary medical records or documentation that establish the patient's need for Emgality are incomplete or insufficient according to UPMC Health Plan's standards.

**Non-Compliance with Dosage Limits:** If the prescription exceeds the dosage limits set by UPMC Health Plan, the coverage for Emgality may be denied.

**Coverage under Another Policy:** If the plan determines that Emgality should be covered under another insurance plan that the patient holds, it might deny coverage under UPMC Health Plan.

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 UPMC Health Plan

Verify Your Policy

Contact UPMC Health Plan customer service to understand what your current policy covers. Ask specifically about coverage for Emgality.

Review your benefits document or the UPMC Health Plan member portal to check for any mention of Emgality coverage and any steps required to obtain it.

Consult with Your Healthcare Provider

Schedule a consultation with your doctor to discuss the need for Emgality in your treatment plan. Explain any migraine issues or other conditions you are experiencing.

Request your healthcare provider to write a prescription for Emgality and to provide any necessary medical documentation that the health plan may require.

Verify Formulary Inclusion

Check the UPMC Health Plan formulary list online or contact customer service to confirm that Emgality is included. This is essential, as not all medications are automatically covered.

If Emgality is not listed, discuss with your healthcare provider about alternatives or the potential for obtaining an exception.

Complete Prior Authorization (If Required)

Your healthcare provider may need to submit a prior authorization request to UPMC Health Plan. This involves providing detailed information on why Emgality is necessary for your treatment.

Ensure that all forms and accompanying documents are filled out correctly and submitted promptly to avoid unnecessary delays.

Understand Coverage Terms

Ask UPMC Health Plan about any copayments, coinsurance, or deductibles you may need to cover when obtaining Emgality.

Inquire if there are any quantity limits, refill rules, or specific pharmacies where your prescription must be filled.

Monitor Your Claims

After receiving Emgality, keep track of your claims to ensure the coverage applies correctly. You can do this through the member portal or regular statements.

Contact customer service immediately if any discrepancies are found in the claims regarding Emgality coverage.

File an Appeal (If Necessary)

If your request for coverage is denied, UPMC Health Plan should provide a reason. File an appeal by submitting the necessary forms and additional documentation supporting your need for Emgality.

Work closely with your doctor during the appeal process to gather all necessary medical evidence and ensure a compelling case.

Follow Up Regularly

Maintain regular contact with both UPMC Health Plan and your healthcare provider to track the progress of your coverage request or appeal.

Update any information as needed and respond swiftly to any requests from UPMC Health Plan to prevent delays in obtaining your medication.

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 UPMC Health Plan Cover Emgality

Explore Emgality coverage with UPMC Health Plan: potential denials, securing coverage, costs without insurance, and FAQs. Learn what to expect.

Achieve Your Goals Faster with Curex