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What does the gammaCore cost? (And is the gammaCore covered by insurance?)

Updated 2/8/18: I have updated information after speaking with a patient education specialist today. What the representative I spoke with Tuesday told me was mostly accurate, but not entirely. I’ve added updates throughout the post. I’m embarrassed by all the changes and apologize for passing on incorrect information.

gammaCore Cost

gammacore cost and insurance coverage

The list gammaCore cost is $600 per device and needs to be “refilled” every 31 days. You have unlimited use of the device for one month, then it will stop working. A “refill” means buying a new device. Yes, you read that correctly—the gammaCore cost is $600 a month ($7,200 a year) without insurance. This pricing model is both ridiculously expensive and wasteful. It’s also 2.5 times what mine cost before it was available in the US market (more on that in a bit).

Update 2/8: The out-of-pocket cost for the foreseeable future is $498 a month ($5,976 a year). The device costs $575 a month and fees for the speciality pharmacy that sends the device add $23 per month, for a total of $598. The pharmacy automatically applies a $100 discount for people with migraine or cluster headache, which electroCore is calling “copay assistance.” The discount applies every month and does not currently have an expiration (though that may change).

gammaCore Insurance Coverage

gammaCore representatives say they are working with all US insurance companies to get the device covered. Currently, coverage is on an individual patient basis. To see if your insurance company will cover it, you need to contact them directly and ask for their protocol for covering medical devices. You will almost certainly need to submit documentation from your doctor about the severity and frequency of your migraine attacks or cluster headache attacks and information on other treatments you have tried. gammaCore customer service can help you determine which information will help make your case with the insurance company. If you decide to purchase the device before getting approval from your insurance company, you can submit for reimbursement (though there’s no guarantee the insurance company will reimburse you). gammaCore customer service ((888) 903-CORE) can help you with that process.

I will be trying to get coverage through my insurance company and will keep you posted on the process.

Update 2/8: gammaCore is supplied through a speciality pharmacy, which will contact your insurance company for you. Your doctor prescribes the device using the gammaCore enrollment form, which they submit to the specialty pharmacy. Before filling the prescription, the specialty pharmacy will contact your insurance company. If your insurance company requests additional information to prove the device is medically necessary, the pharmacy will get the information from your doctor and submit it to insurance. The pharmacy will let you know whether your insurance will cover the device and how much they will pay for. The whole process usually takes about a week.

When I asked if contacting my insurance company directly would help, I was told it wasn’t necessary, but it couldn’t hurt and will raise awareness of the gammaCore as a treatment option.

Two Free Months of gammaCore Use

The gammaCore Patient Registry (GPR) will give a patient with migraine or cluster headache two free months of use if they qualify for the program. The GPR is basically a follow-up study to see how the device works “in the wild” for a large number of patients. If there’s a GPR site near you and you qualify, you may try the device out at no charge for two months in exchange for frequent reporting on your migraine symptoms and use of the device. If you decided to continue using it, you may then qualify for a year of use at a discounted rate. To find out if there’s a GPR site near you, call (888) 903-CORE.

I am going to look into the GPR for myself, but don’t think I will qualify since I’ve been using the device for almost 20 months. I’ll let you know what I learn and if I am able to participate.

Update 2/8: The GPR is currently only for people with episodic cluster headache. There may be a GPR for migraine in the future, but one is not currently in the works.

Patient Assistance Program

Patients who meet financial qualifications may receive a discount on the gammaCore. This is similar to prescription assistance programs, which are income-based. Call (888) 903-CORE for details.

Everyone who orders a gammaCore for migraine or cluster headache gets a $100 “copay assistance” on every order. There is no financial need qualification. This is a $100 discount off the price of the device, no matter if you have insurance or not and no matter how much your insurance covers. The copay assistance is not time-limited, though electroCore may discontinue the program at any time. A patient assistance program may be developed in the future.

My gammaCore Cost Thus Far

I went to Canada to get the gammaCore because it was approved there years before it was available in the US. The pricing model for the device changed last summer, when the gammaCore received FDA approval for cluster headache. The device that used to cost me less than $3,000 a year will now cost $7,200 a year if my insurance doesn’t cover it. Depending on the exchange rate, I used to pay about $550 for a device with 300 uses that could be used in any time frame. Because I get a migraine attack every time I eat, I went down to two meals a day so each device lasted 2.5 months. It used to cost me about $1.85 per use. At the new pricing, it will cost $5 per use. The 300-use device is no longer available; it now needs to be replaced every 31 days in Canada and, I believe, every country it is available. I assume electroCore, the company that makes gammaCore, changed the device settings and pricing model for the US insurance market.

How I Paid for the gammaCore

I received my first gammaCore free (it was the program electroCore offered at the time), then paid for subsequent devices myself. Yes, it was expensive; I justified the cost because it allowed me to increase my productivity at TheraSpecs. The idea with any treatment I try is that if it works, it will pay for itself by allowing me to work more. I know this is a luxury allowed by my unusual work setup, which doesn’t apply to most people.

20 Responses to What does the gammaCore cost? (And is the gammaCore covered by insurance?)

  1. Beth says:

    Wow, I thought the sTMS was expensive! I agree cost is worth it to a certain point if it improves productivity and well being, but am I reading this right that it is $600/month? For those of us most disabled, out of work, un- or under-insured, how is this practical? Thank you so much for updating us and providing numbers to call for support. I’ll be making some calls tomorrow.

    • Hi Beth, yes, you read that correctly. It costs $600 a month without insurance or $7,000 a year! Best of luck with your calls. Please let us know what you learn.

      Take care,
      Kerrie

    • Hi again, Beth, I want to be sure you see the updates I added to the post. I spoke with a more knowledgeable gammaCore employee today who gave more accurate information.

      Take care,
      Kerrie

  2. Becky says:

    What medication does it need to be “refilled” with? If it’s a nerve stimulator, it shouldn’t need to be refilled. I’ve read your other posts but I still don’t quite understand how this device reduces your migraines? I know it’s a vagus nerve stimulator, but how does that relate to migraines and cluster headaches? I’m sorry it’s so expensive! It’s ridiculous, how do they expect anyone to be able to afford it?

  3. Janet Money says:

    I’m in Canada and did not know it was available here. From who, where?

    • Hi Janet, here’s a list of Canadian prescribers: http://gammacore.co.uk/resource-center/find-a-provider#ca (which is an entirely different list than I saw two years ago!). You can also talk to your doctors about it. If you have a headache specialist, that’s probably a good place to start. When I got my prescription in May 2016, any doctor could prescribe it (so could naturopaths and chiropractors) as long as they were willing to contact electroCore to learn the process. Please let me know if you decide to try it!

      Take care,
      Kerrie

    • P.S. I know this list isn’t comprehensive because my local headache specialist contacted two headache specialists who prescribe it and aren’t on the list. Neither would prescribe to patients outside of Canada, but that’s not an issue for you!

  4. Kate says:

    Thanks for the info! Crazy pricing model! So does the patient trash the device once all the uses are gone, or are they turned back in and recycled/reset? If the former, that is also ridiculously wasteful. Do you pick it up at a regular pharmacy (after them ordering it), or is it shipped to you through a specialty pharmacy, or something else?

    The unfortunate thing about these new devices (Cefaly, sTMS, gammacore) is that even with good insurance and them covering it, the cost is likely still high, as it is a medical device. I have good insurance, and pay no more than $50 / prescription (if non formulary brand), have no deductible, no co-insurance, etc, but my coverage on medical equipment is only 60% (which appears to be the norm – very odd).

    Unless things change, these devices won’t be an option for me. I was so bummed that Botox made my daily NDPH headache worse, as it did wonders on my migraines, and was $0 out of pocket, so even cheaper than a generic prescription for me.

    • Hi Kate, I was told to throw mine away. I’ll check to see if they have a return program now, but I’m guessing not. To get the gammaCore, you are connected with a “specialty pharmacy,” which is basically a distribution center. They mail you the initial device and then send replacement devices every month.

      Great point that the cost is high even with good insurance. I’m thinking that because devices are new, insurance companies can use different coverage models than they can get away with for medications.

      I’m sorry to hear Botox made your NDPH worse. How frustrating! There’s some indication that people who respond to Botox for migraine will be good candidates for the CGRP drugs in development. I highly doubt that an interaction with NDPH has come up in the research, though.

      Take care,
      Kerrie

    • HI again, Kate, there is no reuse. Today I was told to recycle it like a cell phone. She told me they’re working on a rechargeable device that you’d update each month with an RFID card. However, I was told the rechargeable device was in the works two years ago.

      Take care,
      Kerrie

  5. jeselle says:

    migraine is expensive already, the cost for gamma core is outrageous
    i used the springTMS (it didn’t work) and never heard from them and now i believe they are tracking me down so i can send it back (it’s wicked heavy and i don’t want to have to pay shipping). i am using cefaly now; it’s much smaller but not feasible to wear at work; it sticks to your forehead and looks very Treky. also insurance is not covering cefaly cost.

    • Jeselle, I agree it’s outrageous. I’m sorry the SpringTMS didn’t work for you. You can probably ask them to send you a prepaid return shipping label to send it back. Is the Cefaly helping you?

      Take care,
      Kerrie

  6. Margo White says:

    I’m irritated that the gamma core device is so expensive. I tried the older Cefaly model with no success but I’m trying the new dual Cefaly with the hope that it works for me this time. I began getting migraines when I was about 10 and over the years they have become chronic daily migraines (since 1998-99). At one point BOTOX was helping but I’ve built up such a tolerance that the BOTOX injections were lasting only a couple of weeks and I can’t afford to pay to have them more frequently as I’m disabled and have been out of work for more than 3 years now and am still waiting for approval for SSDI and Medicare.
    It sucks that it apparently no new devices are covered by insurance, at least not individual insurance policies. I have a huge deductible but then I have no co-pays after I’ve met it. I don’t know about co-pays for medical devices.

    • I’m with you, Margo. It’s ridiculous that these new devices cost so much. And each one that’s announced is more expensive than the last. I’m so sorry you’ve built up a tolerance to Botox. That is so frustrating (I’m going through something similar right now).

      Take care,
      Kerrie

  7. Beth says:

    An update from my call to electroCore: I was told the fee is $575 + a 4-5% pharmacy fee, so yes, right around $600/month. The person I spoke with wasn’t very helpful or knowledgeable answering questions about financial support or insurance, so I’d love to hear what others find out if they call. All he said is they might be able to find a way to make it accessible for me.

    He did let me know my migraine doc’s clinic is a study site; however, when I contacted them, they said it was only for cluster patients. Again, if others find out that their local site is also including migraine patients, I’d love to know. Maybe my doc’s office just isn’t aware that migraine patients will be included soon?

    My doctor’s office did say they would be receiving 1-month copay reimbursement cards. These typically can’t be used with Medicare or Medicaid, though.

    Kerrie – was one month enough time for you to know the gammaCore was effective? Since it’s used acutely, do you know within your first few tries?

    • Hi Beth, thanks for the information. It sounds like their staff isn’t all on the same page; I was told $600 with no mention of the pharmacy fee. As you say, it’s effectively the same price, but it would be nice to know we’re all getting the same information. I do have a call into a gammaCore patient education specialist, who is supposed to be able to better answer financial questions. I’ll let you know if she gives me any further information.

      The person I spoke with at my local patient registry site had no idea what gammaCore even was! I’m supposed to try back to see if the office manager has heard of it. Good to know about the copay reimbursement cards. Did they tell you if there’s a limit to how much they’ll reimburse? Having to pay for the device outright isn’t technically a copay, so they may not cover the full cost. (No worries if you don’t know, I’ll also ask the patient education specialist and my regular headache specialist’s office.)

      The company’s VP of scientific, medical and governmental affairs told me it can take three months to see an improvement, but most patients know after two months if it will work for them. My initial trial was more like two months. I knew by the end of that time that it was doing something good, though I wasn’t sure how much. But it took more than a month to use it at the full strength. I was afraid of using it at too high of a setting. In retrospect, that was an unnecessary worry. Once I got to the full strength, it took a couple weeks before it aborted a migraine attack. I was also in medication overuse headache for the first two months, so it wasn’t a clear trial.

      All that said, I’ve found that if I use it at too high of a setting, it will trigger a rebound migraine attack. I’ll feel fine for a couple hours, then get hit with another attack. So it can take a while to figure out the right setting and, for me, the setting depends on the severity of the migraine attack. And the settings have changed over time. (I’m working on a post all about that.)

      I know that’s a ton of information! Let me know if you have any other questions.

      Take care,
      Kerrie

    • Hi again, Beth. I want to be sure you see that I updated the post above. The patient education specialist was much more knowledgeable than the first person I spoke with. The speciality pharmacy will contact insurance for you, though there’s no guarantee it will be covered. The GPR is only for episodic cluster headache; migraine may be included in the future, but that didn’t sound promising. The person I spoke with didn’t know about the copay card from your doctor’s office, but said that everyone with migraine or cluster headache will automatically get a $100 discount each month from the pharmacy. She didn’t say anything about Medicare or Medicaid. There is no patient assistance program (what the first person told me was a patient assistance program was actually the copay discount).

      Take care,
      Kerrie

  8. Beth says:

    Thank you so much for the update, Kerrie! I’m going to assume the copay card info I got from my doctor’s office is not true at this point.

    $498/month is a lot. Who do they realistically think can afford this? This is disappointing.

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