Emgality™ Savings Card | Emgality (galcanezumab-gnlm)

The information contained in this section of Emgality.com is intended for US healthcare providers. Please confirm below.

Terms and Conditions:
Offer good for up to 12 months until 12/31/2020 if healthcare provider submits the prior authorization form or letter of medical necessity, when required, to the patient’s insurance provider. $0 monthly offer for commercially insured with insurance provider coverage, subject to wholesale acquisition cost plus usual and customary pharmacy charges and a separate $4900 maximum annual cap. $0 monthly offer for commercially insured without insurance provider coverage, subject to monthly and annual cap of wholesale acquisition cost plus usual and customary pharmacy charges.
*By using the Emgality savings card (“Card”), you attest that you meet the eligibility criteria and will comply with the Terms and Conditions described below:

Offer void where prohibited by law. This offer is invalid for patients without commercial insurance coverage or those whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, including, without limitation, Medicaid, Medicare, Medicare Part D, Medigap, DOD, VA, TRICARE/CHAMPUS, or any state patient or pharmaceutical assistance program. If you live in Massachusetts, the Card expires on the earlier of: (i) the expiration date of this Card (12/31/2020); (ii) the date an AB-rated generic equivalent for Emgality becomes available; or (iii) June 30, 2019, absent a change in Massachusetts state law. If you live in California, the Card expires on the earlier of: (i) the expiration date of this Card (12/31/2020) or (ii) the date an FDA-approved therapeutically equivalent for Emgality or over-the-counter product with the same active ingredients becomes available.

Available only in the US and Puerto Rico for residents of the US and Puerto Rico. By accepting this offer, you agree that if you are required to do so under the terms of your insurance coverage for this prescription or are otherwise required to do so by law, you should notify your insurance carrier of your redemption of this Card. This offer is not valid with any other program, discount, incentive, or similar offer involving Emgality. It is prohibited for any person to sell, purchase, or trade; or to offer to sell, purchase, or trade; or to counterfeit this Card. This offer may be terminated, rescinded, revoked, or amended by Lilly USA, LLC, at any time without notice. This Card is not health insurance. This Card expires on 12/31/2020.

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Product support and resources

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Patients can get Emgality FREE for up to 12 months

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Resources for your practice

Emgality Savings Program Resource

Sample Appeal Letter

Sample Letter of Medical Necessity

Emgality Loading Dose Kit (sample)

The Loading Dose Kit (sample) provides patients a chance to administer the first month of Emgality in office. Loading Dose Kits (samples) are intended to assess safety and efficacy for patients in the office.

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