Cost Is One of the Biggest Barriers to Emgality Adherence — Here's How You Can Help

As a prescriber, you already know that Emgality (Galcanezumab) can be a game-changer for patients with frequent migraines or episodic cluster headache. But you've also likely heard from patients who struggle to afford it, delay fills, or abandon treatment altogether because of cost.

Emgality's list price ranges from $700 to $950 per month without insurance. Even with commercial coverage, prior authorization hurdles and high copays can create friction that leads to non-adherence. For patients on Medicare or Medicaid, the picture is even more complicated since manufacturer copay cards don't apply.

This guide is designed to help you — the provider — navigate the savings landscape so you can proactively address cost barriers during the prescribing conversation.

What Your Patients Are Actually Paying

Understanding the cost landscape helps frame conversations with patients:

• Cash price (no insurance): $700–$950/month for one 120 mg injection
• GoodRx coupon price: Starting around $714/month
• With commercial insurance: Varies widely — some patients pay $0-$50/month with a savings card; others face $100-$300+ copays depending on formulary tier and plan design
• Medicare Part D: Coverage possible with prior authorization, but patients may face significant cost-sharing in the coverage gap ("donut hole")
• Uninsured: Full list price without assistance programs

The reality is that many patients will never mention cost until they've already skipped a dose or stopped treatment. Building cost into your standard prescribing workflow catches these issues before they become adherence problems.

Manufacturer Savings Programs

Emgality Savings Card (Eli Lilly)

This is typically the first resource for commercially insured patients:

• Eligible patients may pay as little as $0 for the first month
• $35/month for up to 12 months after that
• Available for patients with commercial insurance
• Not available for patients on government insurance (Medicare, Medicaid, Tricare, VA)
• Patients can enroll at emgality.com or by calling Lilly

Provider tip: Have your staff help patients enroll in the savings card at the time of prescribing — before they get to the pharmacy and see the price. This small step significantly reduces sticker shock and first-fill abandonment.

Lilly Cares Foundation Patient Assistance Program

For uninsured patients who meet income criteria:

• Provides Emgality free of charge
• Income-based eligibility requirements
• Requires prescriber involvement — you'll need to complete an enrollment form
• Covers patients who don't have insurance or whose insurance doesn't cover Emgality

Provider tip: Keep Lilly Cares enrollment forms accessible in your office. The application requires prescriber information and a prescription, so having it ready streamlines the process.

Prescription Hope

A third-party service that helps patients access manufacturer assistance programs:

• Offers Emgality for $70/month for qualifying patients
• Handles paperwork and enrollment on behalf of the patient
• Can be a good option for patients who find direct manufacturer applications overwhelming

Coupon and Discount Cards

For patients who don't qualify for manufacturer programs or need an alternative, several third-party coupon platforms can reduce the cash price:

• GoodRx — Coupon prices starting around $714 for Emgality
• SingleCare — Compare pricing at different pharmacies
• RxSaver — Another coupon comparison tool
• Optum Perks — Discounts at participating pharmacies

While these coupon cards bring the price down from full retail, $700+ per month is still prohibitive for most patients paying out of pocket. Coupons are most useful as a bridge — for example, when a patient is between insurance plans or waiting for prior authorization approval.

Important note for providers: Coupon cards generally cannot be combined with government insurance (Medicare, Medicaid). Patients on these plans need to be directed to patient assistance programs instead.

Generic Alternatives and Therapeutic Substitution

Is There a Generic Emgality?

No. Emgality is a biologic monoclonal antibody, and no biosimilar has been approved as of 2026. Unlike small-molecule drugs that may have cheap generic alternatives, biologic medications face a different regulatory and manufacturing pathway that makes biosimilar development slower and more expensive.

Therapeutic Alternatives Within the CGRP Class

If cost is the primary barrier, consider whether a different CGRP medication might be better covered by the patient's specific insurance plan:

• Aimovig (Erenumab) — Monthly subcutaneous injection (70 mg or 140 mg). Targets the CGRP receptor. Some plans may have it at a lower formulary tier.
• Ajovy (Fremanezumab) — Available as monthly (225 mg) or quarterly (675 mg) injection. The quarterly option means fewer fills per year, which can sometimes reduce overall cost.
• Vyepti (Eptinezumab) — IV infusion every 3 months administered in a healthcare setting. May be covered under medical benefit (Part B) rather than pharmacy benefit (Part D), which can be advantageous for some patients.
• Qulipta (Atogepant) — Oral daily tablet. Sometimes preferred by plans that are resistant to injectable biologics.

Provider tip: Before prescribing, check the patient's formulary (or have your staff check). A 5-minute formulary check can save weeks of prior authorization back-and-forth and prevent patients from facing unexpected costs at the pharmacy.

Non-CGRP Alternatives

For patients who truly cannot afford any CGRP medication, effective and lower-cost migraine preventives include:

• Topiramate (Topamax) — Generic available, typically $10-$30/month
• Propranolol (Inderal) — Generic available, typically $10-$20/month
• Amitriptyline (Elavil) — Generic available, typically $5-$15/month
• Botox (OnabotulinumtoxinA) — For chronic migraine, may be covered under medical benefit

These older medications don't target the CGRP pathway specifically and may have more side effects, but they remain valid options when cost is the deciding factor. Many insurance plans require step therapy through these medications before approving CGRP treatments anyway.

Building Cost Conversations Into Your Workflow

The most effective cost interventions happen before the patient leaves your office, not after they get a surprise bill at the pharmacy. Here are practical steps to integrate cost awareness into your prescribing workflow:

At the Time of Prescribing

1. Ask about insurance coverage — "What type of insurance do you have? Is it commercial, Medicare, or Medicaid?" This immediately determines which savings options are available.
2. Check the formulary — Or have your staff check. This takes minutes and prevents weeks of delays.
3. Enroll in savings programs — For commercially insured patients, help them sign up for the Emgality Savings Card before they leave. For uninsured patients, initiate the Lilly Cares application.
4. Set expectations — "Your first month may cost $0 with the savings card, and $35/month after that. Without the card, it could be several hundred dollars." Transparency builds trust.

At Follow-Up Visits

• Ask about cost — "Have you had any trouble affording or filling your Emgality?" Patients often won't volunteer this information.
• Monitor adherence — Missed fills can be a sign of cost barriers, not treatment failure.
• Reassess annually — Insurance plans change yearly. A medication that was affordable last year may not be this year.

Staff Training

Train your front-office and clinical staff to:

• Recognize when patients express concern about medication costs
• Know where to find savings card enrollment forms and PAP applications
• Follow up on prior authorizations proactively
• Direct patients to resources like Medfinder for Providers for pharmacy availability and stock information

Resources for Your Practice

Bookmark these for quick reference:

• Emgality Savings Card: emgality.com (for commercially insured patients)
• Lilly Cares Foundation: lillycares.com (patient assistance for uninsured)
• Prescription Hope: prescriptionhope.com ($70/month program)
• Medfinder for Providers: medfinder.com/providers (find pharmacies with Emgality in stock)
• NeedyMeds: needymeds.org (comprehensive database of patient assistance programs)
• RxAssist: rxassist.org (patient assistance program directory)

Final Thoughts

Cost doesn't have to be the reason your patients stop a treatment that's working. By building savings conversations into your prescribing workflow, helping patients enroll in programs before they hit the pharmacy, and staying aware of therapeutic alternatives when a specific plan won't cover Emgality, you can significantly improve adherence and outcomes.

The 5 minutes you spend on cost at the point of prescribing can prevent weeks of prior authorization delays, pharmacy callbacks, and — most importantly — missed doses that lead to avoidable migraine days for your patients.

For more information on Emgality supply and availability, see our provider guides on helping patients find Emgality in stock and the Emgality shortage update for prescribers.