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Ubrelvy
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Ubrelvy Health Insurance Denial

Received a Ubrelvy Health Insurance Denial? Contact Us

In December 2019, the FDA approved Ubrelvy (Ubrogepant), an oral CGRP receptor antagonist for the treatment of acute migraines. This article will address Ubrelvy health insurance claim denials, and explain how insurance companies make decisions regarding medical necessity. You will also learn what actions you can take after receiving an Ubrelvy health insurance denial. It can be extremely beneficial for you to contact the Law Offices of Scott Glovsky to ensure you have a strong legal advocate in your corner throughout the process.  

What is Ubrelvy?

In clinical studies, patients took Ubrelvy within four hours of the time their migraine began. Both the 50 and 100 mg doses led to more relief from pain, as well as relief from nausea, sound sensitivity, and light sensitivity at two hours, compared with the group that was given a placebo. Pain relief was defined as a reduction in migraine pain from a moderate to severe level to mild or no pain after taking Ubrelvy. 

How Much Does Ubrelvy Cost?

The list price for a 30-day supply of Ubrelvy is $1,084.85; however, the actual cost for patients can vary significantly, depending on the pharmacy, insurance coverage, and any applicable discounts or patient assistance programs. AbbVie, the manufacturer of Ubrelvy, offers a patient assistance program for eligible individuals. Using discount websites like GoodRX, manufacturer coupons, or getting a 90-day supply can potentially lower the price of Ubrelvy. You can obtain more answers regarding Ubrelvy here

How Does Ubrelvy Work?

Abrelvy is a medication used to treat acute migraine attacks, with or without aura, in adults but is not used for the prevention of migraines. Ubrelvy belongs to a class of drugs called calcitonin gene-related peptide (CGRP) receptor antagonists. 

Is Ubrelvy Fast Acting?

Migraines are believed to be caused by the activation of the CGRP, which is a nerve protein that contributes to headache pain. Ubrelvy blocks CGRP from binding to the receptor. In clinical studies, most people taking Ubrelvy experienced pain relief within two hours. 

The recommended dosage is 50 mg or 100 mg taken orally. A second dose can be taken two hours after the first with no more than 200 mg within a 24-hour period. Ubrelvy should not be taken with CYP3A4 inhibitors like ketoconazole or clarithromycin. Other CBRP inhibitors (gepants) with FDA approval include:

  • Qulipta (atogepant), which is an oral pill for the prevention of migraines rather than the treatment. 
  • Nurtec ODT (Rimegepant sulfate), an oral pill used for both the prevention and treatment of migraines. 
  • Zavzpret (zavegepant), an intranasal spray used for the treatment of migraines. 

CGRP inhibitors include:

  • Aimovig (erenumab-aooe), a subcutaneous injection for the prevention of migraines. 
  • Emgality (galcanezumab-gnlm), a subcutaneous injection used for the prevention of migraines and the treatment of acute episodic cluster headaches.
  • Vyepti (eptinezumab-jjmr), an intravenous infusion injection used in the prevention of migraines. 
  • Ajovy (fremanezumab), a subcutaneous injection used for the prevention of migraines. 

 

Is There a Generic for Ubrelvy?

There is no generic version of Ubrelvy, which is protected by multiple patents. The earliest generic is estimated to be around 2035, with the last patent for Ubrelvy expiring in 2041.  

  

Do Insurance Companies Cover Ubrelvy as a Treatment for Migraines?

Whether your insurance company will cover Ubrelvy to treat migraines will depend on the insurance and your state of residence. Commercial private insurance companies like Healthnet,, UnitedHealthcareAetnaAnthemMedi-Cal Managed Care PlansBlue Shield, and Kaiser Permanente all have different coverages. Many private insurers will cover Ubrelvy as a treatment for migraines if it is deemed medically necessary. If you have received a Ubrelvy claim denial from a private insurer, it can be beneficial to speak to an experienced attorney. 

Government programs like Medicaid and Medicare will typically cover Ubrelvy, although the co-pay may vary significantly. Medicaid (AKA Medi-Cal in California) is a government program for low-income families with no insurance, while Medicare is the federal health insurance program for those 65 and older. Medicare grants this prescription drug coverage through Medicare Advantage Plans (Part C) and Supplemental Plans (Part D). Patients are required to enroll in these plans separately from regular Medicare, which is automatic at age 65. 

Health insurance companies evaluate coverage requests for drugs like Ubrelvy based on internal medical or pharmacy policies. Once a new drug is approved by the FDA, insurers have their internal practitioners including pharmacists, physicians, and others research the drug and develop an internal clinical policy. These internal policies help insurers determine which drugs are medically necessary under a variety of circumstances. 

Once policies are developed, a team of external doctors will vote on those policies. Unfortunately, these doctors may not be entirely unbiased, as they may receive financial incentives or could have the opportunity to work for the insurance companies. This can lead to overly restrictive policies and patients who do not get the drugs their doctors believe are best for their conditions.  

What Can You Do if You Receive a Ubrelvy Health Insurance Denial?

If you receive a Ubrelvy health insurance denial, you do have options, namely appeals. Before you file an appeal, make sure you understand whether your insurance is ERISA (Employment Retirement Income Security Act of 1974) or non-ERISA

Most private employees have ERISA plans except for religious organization plans, government employee plans, individual and family plans through Covered California, business plans that only cover business owners, and individual and family plans purchased through private insurers like Anthem Blue Cross or Blue Shield of California. 

Most health insurers will require prior authorization before covering Ubrelvy or any type of expensive drug or treatment. There are often “catches” in the prior authorization process. A drug may be medically beneficial for a patient, yet the insurer deems it not medically necessary, particularly when there are other similar drugs that can treat the condition. If a (often less expensive) alternative exists, insurers may insist on step therapy

Step Therapy requires patients to take a less expensive alternative drug, usually for 60 days, and often two alternative drugs, before approving the initial prescribed drug. Unfortunately, step therapy can prevent patients from getting the coverage approval for name-brand drugs and harm them by pushing alternatives. Prescription drugs may also be deemed experimental or investigational, meaning the insurance company won’t cover them. 

One reason for an “experimental” or “investigational” label could be because of the off-label use of a drug. Physicians often prescribe drugs off-label, meaning they prescribe the drug for a different condition than the drug was FDA-approved for, in a different dosage, or for a young person rather than an adult. Finally, if the insurer believes the drug does not improve health outcomes, it may be deemed experimental.  

What Duty Do Insurance Companies Have to Members Submitting Claims?

Insurance companies have the following duties to their members who submit claims:

  • The duty to thoroughly investigate claim requests.
  • The duty to fully inquire into all possible reasons that could support requests for care. 
  • The duty to promptly respond to claim requests. 
  • The duty to appoint and employ qualified medical professionals to make claim review decisions. 

Contact the Law Offices of Scott Glovsky if You Receive a Ubrelvy Health Insurance Denial

If you have received a Ubrelvy health insurance denial, you may feel frustrated, anxious, or even angry. After all, you have faithfully paid your insurance premiums, yet now, when you need your insurer, it is leaving you without the care you need. Having a strong legal advocate from the Law Offices of Scott Glovsky can change the outcome of your denied claim. Attorney Scott Glovsky has represented injured consumers and victims of wrongful business practices for more than two decades. Our firm focuses on health insurance bad faithcatastrophic personal injurysexual abuse, and consumer-related litigation. We seek justice for our clients while holding the wrongdoers accountable. 

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