The Cost Challenge with Nayzilam

Nayzilam (Midazolam nasal spray) is an effective rescue medication for seizure clusters, but its cost can be a significant barrier to patient adherence. With a cash price of approximately $884 per pack of 2 devices and no generic alternative available as of 2026, many patients face financial challenges in keeping this critical medication on hand.

As a prescribing provider, you play a key role in connecting patients with savings programs and navigating insurance barriers. This guide consolidates the available options to help streamline that process. For clinical context on supply challenges, see our provider-focused shortage update.

Manufacturer Savings Programs

Nayzilam Savings Card

UCB Pharma offers a manufacturer savings card for Nayzilam that can significantly reduce patient out-of-pocket costs:

• Eligible patients: Commercially insured individuals
• Potential savings: Eligible patients may pay as little as $0 per prescription
• Exclusions: Not valid for patients enrolled in Medicare, Medicaid, TRICARE, or other federal or state healthcare programs
• How to access: Patients can enroll at nayzilam.com/savings or your office can assist with enrollment

This should be the first option explored for commercially insured patients. The enrollment process is straightforward and can often be completed during the office visit.

UCBCares Patient Support

UCB Pharma's patient support program, UCBCares, offers broader assistance beyond the savings card:

• Help with insurance verification and prior authorization
• Patient assistance for eligible uninsured or underinsured patients
• Coordination of specialty pharmacy services
• General medication support and education

Providers can contact UCBCares directly to initiate support for their patients. This is particularly valuable for patients who don't qualify for the savings card due to government insurance.

Third-Party Coupon and Discount Programs

For patients who don't qualify for manufacturer programs or need additional savings, several third-party discount platforms may offer reduced pricing:

• SingleCare — Has shown prices around $629 for Nayzilam, a meaningful reduction from the $884 cash price
• GoodRx — Aggregates pharmacy pricing and may offer coupons
• RxSaver — Another option for comparing pharmacy prices
• Optum Perks — Discount card program

These programs are free for patients to use and are accepted at most major pharmacy chains. They can be especially helpful for uninsured patients or those with high-deductible plans who haven't met their deductible.

Clinical note: Coupon card pricing varies by pharmacy location. Advise patients to compare prices across multiple pharmacies before filling. Tools like MedFinder for Providers can assist with locating pharmacies that have Nayzilam in stock.

Patient Assistance Programs (PAPs)

For patients with demonstrated financial hardship — particularly those who are uninsured or underinsured — patient assistance programs may provide Nayzilam at no cost or significantly reduced cost:

• UCBCares Patient Assistance — UCB's own program for eligible patients; contact UCBCares directly for application details
• NeedyMeds (needymeds.org) — Comprehensive database of assistance programs including manufacturer programs for Nayzilam
• RxAssist (rxassist.org) — Another database of patient assistance resources

PAPs typically require documentation of income and insurance status. Processing times vary, so initiating the application early is advisable — particularly for a rescue medication that patients need available at all times.

Navigating Insurance Coverage

Insurance coverage for Nayzilam varies considerably across payers. Common barriers include:

Prior Authorization

Most commercial and government payers require prior authorization for Nayzilam. To improve approval rates:

• Document the patient's seizure cluster history thoroughly, including frequency, duration, and impact
• Note any previous rescue medications tried and their outcomes
• Include relevant EEG or seizure diary data supporting the diagnosis of seizure clusters
• Reference the FDA-approved indication: acute treatment of intermittent, stereotypic episodes of frequent seizure activity in patients with epilepsy aged 12+

Step Therapy Requirements

Some plans require patients to try other rescue medications before approving Nayzilam, typically:

• Diastat (Diazepam rectal gel) — Often the required first-line rescue medication for payers
• Valtoco (Diazepam nasal spray) — Another intranasal option that some plans may require trialing first

When step therapy is required, document specific clinical reasons why Nayzilam is preferred. Relevant considerations include route of administration preference, prior adverse reactions to Diazepam, caregiver comfort with administration, and patient dignity concerns — particularly for adolescent patients or those who require rescue medication in public settings.

Appeals

If initial authorization is denied:

1. Review the denial reason carefully
2. Submit a peer-to-peer review request if available
3. Provide additional clinical documentation supporting medical necessity
4. Consider involving the patient — some payers respond to patient advocacy

For a comprehensive overview of alternatives when access is limited, see our guide on helping patients find Nayzilam in stock.

Specialty Pharmacy Considerations

Some insurance plans require Nayzilam to be dispensed through a specialty pharmacy. While this adds a step, specialty pharmacies often have:

• More reliable stock of Nayzilam compared to retail pharmacies
• Dedicated teams to assist with prior authorization and appeals
• Financial counselors who can help patients identify savings opportunities
• Mail-order delivery options for patient convenience

When referring patients to a specialty pharmacy, confirm the pharmacy is in-network to avoid unexpected costs.

Cost Conversations: Best Practices

Many patients won't bring up cost concerns proactively. Consider these approaches:

• Ask about cost barriers early — "Have you had any difficulty affording or filling this prescription?"
• Provide savings card information at the time of prescribing — Don't assume patients will find it on their own
• Involve your office staff — Designate a team member to help with savings card enrollment and PAP applications
• Follow up — Check at the next visit whether the patient was able to fill the prescription and keep it on hand

An unfilled rescue medication provides no clinical benefit. Cost intervention is a clinical intervention.

Quick Reference: Savings Options by Patient Type

Additional Resources for Providers

• Nayzilam shortage: what providers need to know in 2026
• How to help your patients find Nayzilam in stock
• Alternative rescue medications for seizure clusters
• Nayzilam drug interactions

For patient-facing resources on this topic, you can direct patients to our guide on how to save money on Nayzilam. Providers can also use MedFinder for Providers to assist with pharmacy availability searches and streamline the prescription filling process.