Nurtec assistance for Medicare patients

In this article:

• Does Medicare cover Nurtec?
• How much does Nurtec cost with Medicare?
• Nurtec assistance for Medicare patients

In this article

• Does Medicare cover Nurtec?
• How much does Nurtec cost with Medicare?
• Nurtec assistance for Medicare patients

Anyone who has experienced the head-throbbing, nausea-inducing effects of a migraine knows that when they strike, all you want is relief—and Nurtec (rimegepant) can deliver it. As a calcitonin gene-related peptide (CGRP) receptor antagonist, it blocks a protein related to migraine attacks. It’s approved to treat acute migraines with or without aura, as well as prevent episodic migraines. But Nurtec can also be pricey for some, and you may wonder if your Medicare plan will help cover it. Many plans will, but there are several factors to consider. 

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Does Medicare cover Nurtec?

Many times, yes. Medicare Parts A and B do not include prescription drug plans, so they won’t cover it. However, Part D beneficiaries will typically receive some coverage. In fact, according to the Centers for Medicare & Medicaid Services, Part D plans issued over $478 million for Nurtec coverage in 2023. That’s around $5,706 per beneficiary.

It’s not always simple, though. Some health insurance plans might require prior authorization, which is how the insurance company confirms that the medication is medically necessary. “Typical prior authorization for Nurtec includes diagnosis confirmation, there needs to be documentation that a patient has migraines with or without aura (often with a required minimum number of monthly migraine days),” says Dr. Edmond Hakimi, DO, medical director at Wellbridge. “Additionally, step therapy is often required—this means proof that a patient has tried and failed, had inadequate responses, or intolerance to at least two different triptans (like sumantriptan or rizatripan).”

In addition, Dr. Hakimi says some insurance companies require the prescription to come from a neurologist or headache specialist rather than a primary care provider in order for the insurance company to approve the medication. This, in itself, may make it difficult for patients to receive medication, especially if they are not established with a neurologist or live in a rural area.

How much does Nurtec cost with Medicare?

For anyone paying completely out of pocket, eight tablets of Nurtec can cost around $1,369. However, the drug might cost significantly less for people whose Medicare Part D plans cover it. Your specific copay, however, depends on your plan’s deductible and coinsurance policies. It is best to check online with your insurance, as the insurance company’s policy and your out-of-pocket cost can change anytime. 

Typically, you’ll need to pay the full cost of Nurtec (or other prescription medicine) until your deductible is reached. While deductibles vary, Medicare Part D deductibles only go up to $590. After that, you’ll pay 25% co-insurance until your out-of-pocket costs hit $2,000—the annual limit. Insurance will cover 100% of your prescription drug costs for the rest of the year.

For example, to hit your deductible for your first Nurtec prescription, you may need to pay $590. After that, you could pay around $342 per prescription (25% of $1,369) until you reach $2,000.

Nurtec assistance for Medicare patients

Even with insurance coverage, Nurtec often comes with some costs. There isn’t an approved generic version yet, but there are still several ways to save money. Here are a few of the most common:

Get free Nurtec coupons

A SingleCare coupon card can knock the 8-pill price of Nurtec down from $1,367 to as low as $870. It’s completely free—you just have to sign up and present your card at a participating pharmacy. You can use SingleCare even if you’re enrolled in a Medicare Part D plan, but can’t use the savings on top of your Medicare coverage.

Look into the Pfizer patient assistance program

Nurtec’s manufacturer, Pfizer, has patient support and a savings program for people who need additional assistance paying for their prescription medications. However, you have to meet certain eligibility requirements to qualify. Medicare Part D beneficiaries must enroll in the Medicare Prescription Payment Plan and complete prior authorization (if necessary). Additionally, they must:

• Attest to their inability to afford their prescription medications.
• Have an FDA-approved diagnosis for a condition that requires Nurtec.
• Have an annual household pre-tax income less than 300% of the Federal Poverty Level.
• Have a valid prescription from a US-licensed healthcare provider.
• Be a resident of the U.S. or a U.S. territory like Puerto Rico.

Patients who meet these requirements and qualify for the program may receive Nurtec for free.

Consider Medicare Extra Help

Medicare has its own program (Extra Help) that helps beneficiaries who need assistance paying their prescription expenses—including premiums, deductibles, and coinsurance. Eligible patients have to earn less than $23,475 per year, and can’t have more than $17,600 in resources (stocks, bonds, etc.). For married couples, those numbers go up to $31,725 and $35,130, respectively. People who qualify for Extra Help will have a $0 deductible, and they’ll only pay up to $12.15 for each brand-name drug.

Apply for Medicaid

Whether or not you have insurance, Medicaid can help cover your out-of-pocket prescription costs. Like Extra Help, qualifying applicants have to meet certain income requirements—but since it’s partially funded by state governments, these can vary between states. This page lets you look up the specific requirements by state or check your state government’s website. It’s also worth noting that any Medicare beneficiary who enrolls in Medicaid will automatically receive Extra Help benefits.

Ask about alternatives

Nurtec doesn’t have an approved generic version yet—and the drug’s patent doesn’t expire until 2039—but other migraine medications might be less expensive or receive better coverage from your insurance plan. According to Dr. Hakimi, when it’s used to treat acute migraine attacks, Nurtec alternatives include:

• Triptans like eletriptan or frovatriptan
• Over-the-counter NSAIDs like ibuprofen and naproxen
• Other CGRP inhibitors like Ubrelvy, Zavzpret, Qulipta, Emgality, or Aimovig
• selective serotonin receptor agonists like Reyvow

And when it’s used for preventative therapy, he says options include:

• Oral preventives like beta blockers, anticonvulsants, or tricyclic antidepressants
• CGRP monoclonal antibodies
• Botox (for chronic cases).

Be sure to consult a healthcare professional before switching migraine drugs. They can provide medical advice on which alternative might work best for you.

90-day prescriptions

Sometimes, getting a larger prescription can help lower your out-of-pocket costs. While many prescriptions are for 30 days, healthcare providers may agree to write them for 90 days instead. Not only do these save you from going to the pharmacy every month, but studies have shown that they can lead to savings, better medication adherence, greater persistence, and nominal wastage. So it’s worth asking your healthcare provider if they’d be open to writing a 90-day prescription instead.

Free samples

Some healthcare providers carry free samples of certain drugs, so patients can try them before filling a larger prescription at the pharmacy. Usually, it’s just a couple of doses, so this isn’t a long-term solution, but it’s a more affordable way to see if Nurtec treatment works for you.