Does Medicaid cover Nurtec?

In this article:

• Does Medicaid cover Nurtec ODT?
• Factors influencing Medicaid coverage for Nurtec ODT
• How much does Nurtec ODT cost?
• Cost of Nurtec ODT with Medicaid
• How to get Nurtec ODT with Medicaid
• Ways to get discounts on Nurtec ODT without Medicaid

In this article

• Does Medicaid cover Nurtec ODT?
• Factors influencing Medicaid coverage for Nurtec ODT
• How much does Nurtec ODT cost?
• Cost of Nurtec ODT with Medicaid
• How to get Nurtec ODT with Medicaid
• Ways to get discounts on Nurtec ODT without Medicaid

Migraines can be challenging for those who suffer from them. If you experience acute or episodic migraines, you understand how crucial it is to find an effective treatment. Nurtec ODT (rimegepant) is a brand-name prescription medication that’s taken as an orally disintegrating tablet (ODT). It works by blocking calcitonin gene-related peptide (CGRP), a protein responsible for migraine pain. You can take Nurtec ODT as needed for immediate relief of acute migraine or every other day as a preventive treatment for chronic migraine. Nurtec ODT can be expensive, especially without insurance. Understanding Medicaid coverage can make a huge difference in managing migraines.

Does Medicaid cover Nurtec ODT?

Medicaid coverage for medications can vary significantly based on the state in which you reside. Each state has its own Medicaid guidelines for drug coverage. For example, Texas Medicaid covers Nurtec as a preferred drug, but it requires prior authorization and proof that other treatments have not been effective. Michigan Medicaid covers Nurtec as a preferred drug, but it requires prior authorization and has age requirements and quantity limits.  

To determine if your state covers Nurtec ODT, check your state’s Medicaid website or call your local Medicaid office. They can tell you if Nurtec ODT is covered and what you need to do to get it.

Factors influencing Medicaid coverage for Nurtec ODT

If your state’s Medicaid program does cover Nurtec ODT, there may be specific criteria you need to meet. For example, many Medicaid programs require prior authorization before covering certain medications. This special approval processes your healthcare provider to submit a request to Medicaid explaining why Nurtec ODT is needed for your treatment. They may also require step therapy, which involves trying a less expensive migraine treatment before covering Nurtec ODT. 

How much does Nurtec ODT cost?

The average retail price of Nurtec is $1,327 for a box of 8 orally disintegrating tablets. The price fluctuates, though, and it varies greatly by dosage, pharmacy, and location, among other factors. If you have insurance, Medicare, or Medicaid, you’ll likely pay much less.

Cost of Nurtec ODT with Medicaid

The cost of Nurtec with Medicaid will depend on your specific plan and state guidelines. Medicaid generally helps reduce medication costs, but you might still have some expenses:

• Copays: Medicaid plans may require a copayment, a small fee you pay for your medication. Depending on your state’s rules, this copayment can vary, with averages ranging from less than $1 to $15 or more.
• Coinsurance: Some Medicaid plans might require paying a percentage of the medication’s cost.
• Monthly premiums: In some states, Medicaid beneficiaries may have small monthly premiums, though many do not.

Let your healthcare provider or pharmacist help you figure out your out-of-pocket costs. They can review your Medicaid plan or call your local Medicaid office.

How to get Nurtec ODT with Medicaid

If you’re eligible to receive Medicaid and your healthcare provider prescribes Nurtec ODT, follow these steps to obtain the medication:

• Visit your healthcare provider: Your healthcare provider needs to prescribe Nurtec ODT and send the prescription to a pharmacy that accepts Medicaid.
• Verify coverage: Check with your state’s Medicaid program to confirm whether Nurtec is covered. You can do this by visiting the program’s website or calling the local Medicaid office.
• Obtain prior authorization: In some cases, Medicaid might require a special request, called prior authorization, before it covers Nurtec ODT. This means your healthcare provider must submit a request to Medicaid explaining why Nurtec is necessary for your treatment. The initial authorization process can take up to a week, though often it may be quicker.
• Have your prescription filled: Once the request is approved, you can pick up your prescription at your local pharmacy.

Ways to get discounts on Nurtec ODT without Medicaid

If you don’t have Medicaid or don’t meet your state’s coverage requirements for Nurtec, there are ways to save. One way is to use a SingleCare prescription discount card. This card provides immediate access to digital coupons at many pharmacies, making it more affordable. For example, with a SingleCare coupon for Nurtec ODT, you could pay $836 instead of $1,327 for 8 tablets.  

Another option is the Nurtec copay card, however, it isn’t available to people enrolled in a state or federally-funded insurance program, including Medicaid, Medicare, TRICARE, Veteran Affairs health care, or a state prescription drug assistance program. 

Navigating the cost of medications like Nurtec ODT can be challenging. While Medicaid coverage for Nurtec ODT varies by state, taking proactive steps can help manage the price of this critical medication. Whether through Medicaid coverage, discount programs, or other savings options, there are ways to make Nurtec ODT more affordable for effective migraine management.