FOR U.S. HEALTHCARE PROFESSIONALS ONLY
Savings & Support
*Per IQVIA as oral brand in class (oral CGRP receptor antagonists): number one prescribed and number one in new prescriptions, since 8/6/21. Data current as of 8/21/23.
Nurtec® OneSource: one stop for resources and
personalized patient support
Help give your patients access to the only migraine medication that treats and prevents all in one with our dedicated savings and support program.1,2 Call 1-833-4NURTEC for support with any of the following:
ACCESS FOR YOUR COMMERCIALLY INSURED PATIENTS
†As long as coverage is being investigated until the end of 2023.
‡Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico. The offer will be accepted only at participating pharmacies. This offer is not health insurance. No membership fees apply. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. For any questions, please call 1-800-761-1568. See the full or write to Pfizer Inc., at PO Box 29387, Mission, KS 66201.
SUPPORT FOR ALL PATIENTS
How to prescribe
Nurtec® ODT (rimegepant) 75 mg
Nurtec ODT 75 mg is available in blister packs of 8 tablets each. For preventive treatment, prescribe two 8-packs (16 tablets) per month. For acute treatment, you can prescribe one 8-pack, or double up to two 8-packs in one monthly prescription.1,*
1
In your EMR, simply select:
ASPN Pharmacies, LLC
290 West Mount Pleasant Ave, Livingston, NJ 07039 NPI: 1538590690 Prescriptions can also be faxed to ASPN Pharmacies at 1-877-371-2213.
A
or
Your local pharmacy
(for prescriptions not serviced through Nurtec® OneSource)
B
Don’t see ASPN Pharmacies in your ePrescribe platform?
Select ASPN Pharmacy in your EMR mail order pharmacy option or check with your IT support for the last system update. If additional assistance is needed, please contact your EMR provider.
2
Select ICD-10-CM code*:
The codes listed below may be appropriate to include with your request for your patient with migraine. Please refer to an ICD-10-CM resource for additional codes that may be applicable to your patient.
ICD-10-CM code and description
- G43, Migraine
- G43.0, Migraine without aura
- G43.1, Migraine with aura
- G43.9, Migraine, unspecified
3
Select quantity:
1 blister pack (8 tablets)
NDC: 72618-3000-02
A
or
2 blister packs (16 tablets)
NDC: 72618-3000-02
B
Include directions for use as appropriate
ACUTE: Take one tablet by mouth daily as needed for migraine. No more than one dose in 24 hours.
PREVENTIVE: Take one tablet by mouth every other day. No more than one dose in 24 hours.
Have questions for a Support Specialist?
Call 1-833-4NURTEC (1-833-468-7832) Monday through Friday from 8:30 am to 8:00 pm EST.
*The maximum dose of Nurtec ODT in a 24-hour period is 75 mg. The safety of using more than 18 doses of Nurtec ODT in a 30-day period has not been established.1
†Codes are provided for informational purposes only. List may not be comprehensive. The healthcare provider is responsible for determining appropriate coding for treatment of their patients. Codes are not intended to encourage or suggest a use that is inconsistent with FDA-approved uses.
Nurtec ODT access support and copay card
If patients are not utilizing Nurtec® OneSource, other options are available to help with prior authorization and affordability.
NURTEC ODT COPAY CARD
Eligible patients with commercial insurance may pay as little as $0 per month*
Let your eligible patients know they can download and activate a card today by visiting nurtec.com/savings
*Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico. The offer will be accepted only at participating pharmacies. This offer is not health insurance. No membership fees apply. Pfizer reserves the right to rescind, revoke, or amend this offer without notice. For any questions, please call 1-800-761-1568. See the full or write to Pfizer Inc., at PO Box 29387, Mission, KS 66201.
More than 286 million individuals have access to Nurtec ODT across all channels*
With coverage for 96% of commercially insured lives*
Nurtec ODT is a preferred oral CGRP receptor antagonist on the UnitedHealthcare national commercial formulary(acute: 8 tablets/30 days; preventive: 16 tablets/30 days)†
Nurtec ODT is the only oral CGRP receptor antagonist on the Anthem national commercial formulary(acute: 8 tablets/30 days; preventive: 18 tablets/30 days)†
Nurtec ODT is a preferred oral CGRP receptor antagonist on the Aetna national commercial formulary(acute: 16 tablets/30 days; preventive: 16 tablets/30 days)†
Nurtec ODT is a preferred oral CGRP receptor antagonist on the Cigna national commercial formulary(acute: 15 tablets/30 days; preventive: 15 tablets/30 days)†
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Most insurance plans cover a monthly prescription for two 8-packs of Nurtec ODT (16 tablets) for acute treatment of migraine*
The maximum dose of Nurtec ODT in a 24-hour period is 75 mg. The safety of using more than 18 doses of Nurtec ODT in a 30-day period has not been established.1
SELECT NATIONAL PLANS WITH 16-TABLET COVERAGE FOR ACUTE TREATMENT†
| PHARMACY BENEFIT MANAGER | PLAN STATUS | ACUTE QL |
|---|---|---|
| CVS | Preferred | 16 |
| AETNA | Preferred | 16 |
| MEDIMPACT | Preferred | 16 |
| BLUE CROSS BLUE SHIELD FEP | Covered | 18‡ |
FEP=Federal Employee Program; QL=quantity limit
*Per Managed Markets Insights and Technology LLC as of 7/24/23.
†Pfizer does not claim to make this information as timely and accurate as possible, they make no claims, promises, or guarantees about the accuracy, completeness, or adequacy of the contents, and expressly disclaim liability for errors and omissions in the contents. Pfizer does not guarantee coverage of insured benefits: all benefits are subject to the insured's plan requirements. Please consult the health plan directly for comprehensive policy information. Upon rendering his or her own independent clinical judgment, it is up to the healthcare professional to determine patient specific coverage. Sources: Managed Markets Insight & Technology, LLC database as of March, 2023. IQVIA database as of February, 2023.
‡Acute quantity limit is 56 tablets per 90-day prescription.
References: 1. Nurtec ODT. Package insert. Pfizer Inc. 2. Croop R, Lipton RB, Kudrow D, et al. Oral rimegepant for preventive treatment of migraine: a phase 2/3, randomised, double-blind, placebo-controlled trial. Lancet. 2020;397(10268): 51-60. doi:10.1016/S0140-6736(20)32544-7.
Savings Program Terms & Conditions
To the Patient: By using this copay card, you acknowledge that you currently meet the eligibility criteria and will comply with the terms and conditions described below:
- Patients are not eligible to use this card if they are enrolled in a state or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veteran Affairs health care, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico (formerly known as "La Reforma de Salud").
- Patient must have private/commercial insurance. Offer is not valid for cash paying patients.
- Eligible patients with commercial insurance and a script for Nurtec ODT may pay as little as $0 out of pocket for a 30-day supply. The copay card may not be redeemed more than once per 30 days per patient.
- This copay card and rebate are not valid when the entire cost of your prescription drug is eligible to be reimbursed by your private/commercial insurance plan or other private/commercial health or pharmacy benefit programs.
- You must deduct the value of this copay card from any reimbursement request submitted to your private/commercial insurance plan, either directly by you or on your behalf.
- You are responsible for reporting use of the copay card to any private/commercial insurer, health plan, or other third party who pays for or reimburses any part of the prescription filled using the copay card, as may be required. You should not use the copay card if your insurer or health plan prohibits use of manufacturer copay cards.
- You must be 18 years of age or older to redeem the copay card under this program.
- This copay card is not valid where prohibited by law.
- The copay card cannot be combined with any other savings, free trial, or similar offer for the specified prescription.
- Copay card will be accepted only at participating pharmacies.
- This copay card is not health insurance.
- Offer good only in the U.S. and Puerto Rico.
- Copay card is limited to 1 per person during this offering period and is not transferable.
- No other purchase is necessary.
- Data related to your redemption of the copay card may be collected, analyzed and shared with Pfizer for market research and other purposes related to assessing Pfizer’s programs. Data shared with Pfizer will be aggregated and de-identified; it will be combined with data related to other copay card redemptions and will not identify you.
- Pfizer reserves the right to rescind, revoke or amend this offer without notice.
- Offer expires 12/31/24.
To the Pharmacist: By redeeming this offer, the Pharmacist certifies: (a) that the Pharmacy has not submitted, and will not submit, a claim for reimbursement under any federal, state, or other government programs for this prescription or where prohibited by law and (b) the Pharmacist will adhere to the terms and conditions stated above.
Pharmacist Instructions: For Commercially Insured Patients, please submit this claim to the patient's primary Third-Party Payer first, then submit the balance due to CHANGE HEALTHCARE as a Secondary Payer COB (coordination of benefits) with patient responsibility and a valid Other Coverage Code (e.g. 08). If the claim is rejected due to Prior Authorization, Step-edit or NDC Block, continue processing the Nurtec ODT Savings Card as a secondary payer COB with valid Other Coverage Code of 03. An approved PA will be required for all subsequent fills. Reimbursement will be received from CHANGE HEALTHCARE. For questions, please call the Concierge line for Nurtec ODT at 1‑800‑731‑4997, Monday — Friday, 8 am — 8 pm ET.