Your Patients Need Emgality — Here's How to Help Them Get It

You've prescribed Emgality (Galcanezumab-gnlm) for your migraine patient. The prior auth went through. Everything should be straightforward — but then your patient calls to say the pharmacy doesn't have it. And neither does the next pharmacy, or the one after that.

Emgality availability has been a recurring challenge since late 2022, and as a prescriber, you're in a unique position to help your patients navigate it. This guide provides practical, actionable steps you can integrate into your clinical workflow.

Current Availability Landscape

Emgality is listed on the ASHP drug shortage list due to increased demand. Eli Lilly, the sole manufacturer, has not reported a manufacturing disruption — this is primarily a demand-driven constraint. Key points:

• No generic or biosimilar is available as of 2026
• Supply is inconsistent across pharmacy types and regions
• Specialty and mail-order pharmacies generally have more reliable stock than retail chains
• The shortage has persisted in various degrees since late 2022

For a full timeline and analysis, see our clinical briefing: Emgality shortage: What providers and prescribers need to know in 2026.

Why Patients Can't Find Emgality

Understanding the root causes helps you counsel patients effectively:

• Retail pharmacy stocking patterns: Chain pharmacies order based on historical demand. If a pharmacy hasn't dispensed Emgality recently, they may not stock it, creating a chicken-and-egg problem for new patients.
• Cold-chain requirements: Emgality must be stored at 36-46°F. Some pharmacies have limited refrigerated space for biologics and don't stock more than what's immediately needed.
• Wholesaler allocation: When supply is constrained, wholesalers may limit quantities per pharmacy, prioritizing accounts with historical ordering volume.
• Prior auth timing: Delays in prior authorization create gaps between prescribing and dispensing, during which pharmacy stock may be allocated elsewhere.

5 Steps Providers Can Take to Help

Step 1: Check Real-Time Stock with Medfinder

Before your patient leaves the office, check Medfinder for Providers to identify pharmacies in their area that currently have Emgality in stock. Providing a specific pharmacy name and phone number at the point of care saves the patient from making multiple calls and reduces the likelihood of a treatment gap.

Consider bookmarking Medfinder in your clinical workspace for quick access during appointments.

Step 2: Route Prescriptions to Specialty Pharmacies

Specialty pharmacies are significantly more reliable for biologic availability than retail chains. When prescribing Emgality:

• Check if the patient's insurance plan designates a preferred specialty pharmacy
• If not, consider directing the prescription to a national specialty pharmacy that stocks CGRP inhibitors
• Mail-order specialty services often ship with cold packs directly to the patient's home, bypassing local stock issues entirely

Step 3: Initiate Prior Auth Early

Don't wait until the patient is due for their next injection. Submit prior authorization as soon as you decide to prescribe Emgality. For new patients starting with a loading dose:

• Submit the PA at the prescribing visit, not after
• Use Eli Lilly's PA support tools at emgality.lilly.com/hcp to identify payer-specific requirements
• Document step therapy failures thoroughly — most insurers require evidence of failure on 2+ preventive medications (commonly Topiramate, Propranolol, Amitriptyline, or Venlafaxine)

Step 4: Enroll Patients in Savings Programs

Cost barriers can compound availability issues. At the point of prescribing, proactively connect patients with:

• Emgality Savings Card: Commercially insured patients pay as little as $0 for the first month, then $35/month for up to 12 months
• Lilly Cares Foundation: Free medication for qualifying uninsured patients
• Prescription Hope: $70/month for qualifying patients regardless of insurance status

Having brochures or QR codes for these programs in your office can streamline enrollment. For detailed guidance, see How to help patients save money on Emgality: A provider's guide.

Step 5: Have a Backup CGRP Inhibitor Identified

For every patient on Emgality, consider proactively identifying which alternative CGRP inhibitor you would switch to if supply becomes unavailable. Document this in the patient's chart so that if a switch is needed, you can act quickly rather than starting the decision process from scratch.

Factors to consider when selecting a backup:

• Insurance formulary: Which alternatives are covered? Is step therapy required?
• Patient preference: Does the patient prefer monthly injection, quarterly injection, quarterly IV infusion, or daily oral medication?
• Clinical considerations: Has the patient tried other CGRP inhibitors previously? Any relevant contraindications?

Alternative CGRP Inhibitors at a Glance

• Ajovy (Fremanezumab): Most pharmacologically similar to Emgality (same CGRP ligand target). Monthly or quarterly SC injection. Easiest transition for patients stable on Emgality.
• Aimovig (Erenumab): CGRP receptor antagonist. Monthly SC injection. Consider if CGRP ligand antibodies have been suboptimal.
• Vyepti (Eptinezumab): CGRP ligand target. Quarterly IV infusion. Best for patients who benefit from provider-administered treatment and want less frequent dosing.
• Qulipta (Atogepant): Oral CGRP receptor antagonist. Daily pill. Best for injection-averse patients.

Direct patients to our consumer-facing alternatives guide: Alternatives to Emgality if you can't fill your prescription.

Workflow Tips for Your Practice

Here are some operational suggestions to reduce Emgality-related friction in your practice:

• Standardize pharmacy routing: Create a default specialty pharmacy recommendation for biologic prescriptions. This reduces variability and improves fill rates.
• Track patient fill status: Ask about medication access at every follow-up. Patients may not proactively report supply issues.
• Batch PA submissions: If you have multiple patients starting CGRP inhibitors, batch your prior auth submissions to improve efficiency.
• Educate your staff: Make sure your nurses and medical assistants know about Medfinder, the Emgality Savings Card, and Lilly Cares so they can assist patients proactively.
• Keep alternative prescriptions ready: For patients with a documented history of Emgality supply issues, consider having a signed backup prescription for an alternative CGRP inhibitor on file.

Final Thoughts

The Emgality shortage is a logistics problem, not a clinical one. The medication works. The evidence is strong. The challenge is getting it into your patient's hands consistently.

By integrating real-time stock tools like Medfinder, routing prescriptions to specialty pharmacies, initiating prior auth early, connecting patients with savings programs, and having backup alternatives identified, you can significantly reduce treatment gaps for your migraine patients.

Your patients are counting on you to help them navigate a complicated medication landscape. These five steps make that navigation easier — for them and for your practice.