How to Prescribe
Eligible, commercially-insured patients may pay as little as $40 per carton*
4 single-dose autoinjectors per carton1
How to prescribe Brekiya autoinjector
Step 1
Send their prescription to one of the following specialty pharmacies:
Sterling Specialty Pharmacy
1312 Northland Drive, Suite 500,
Mendota Heights, MN 55120
Phone number: 888-618-4126
To minimize callbacks, be sure to include the ICD-10 Code and patient cell phone number on the prescription. Standard data rates may apply.
Step 2
The specialty pharmacies
The specialty pharmacy will conduct a benefits investigation to confirm your patient’s insurance coverage. Their staff is already familiar with the correct billing and coding information to assist with the initial claim, and additionnal paperwork, including:
- Prior Authorizations
- Letters of Medical Necessity or Exception (sample letters are available below)
The specialty pharmacies may reach out to your patient for additional information, if needed.
Step 3
The specialty pharmacies will mail Brekiya autoinjector directly to your patient’s preferred location.
Financial assistance may be available for eligible patients prescribed Brekiya autoinjector
PROGRAM OPTIONS ARE BELOW:
Copay Program
Head Start Program
To determine eligibility for the Head Start program, your patient must have:
- Previously submitted a prescription through one of the two specialty pharmacies
- A denied prior authorization with an appeal pending
Eligible patients who meet the criteria above may receive up to 3 Brekiya autoinjector cartons (4 single-dose autoinjectors per carton) at no cost within a consecutive 90-day period until a
coverage decision is rendered.
Please send a new prescription with ICD-10 code to:
TC Script, LLC
NPI: 1104391770
8275 N. Pima Road, Suite 1, Scottsdale, AZ 85258
Phone: 855-584-6189
Fax: 855-578-1691
Patient Assistance Program
Assists eligible patients who do not currently have insurance coverage for Brekiya autoinjector. Eligibility is determined after a complete application is received. Terms and conditions apply including financial eligibility criteria. To submit an application and assess whether a patient may be eligible for this program, please follow the instructions to complete the enrollment form.
Help your Veteran Patients
Brekiya autoinjector is now available on the VA National Formulary†.
Eligible patients may pay as little as $11 per carton*.
2-steps process to follow:
- Submit a Non-Formulary Request (NFR) into the VA Pharmacy at the Veteran’s authorizing VAMC, addressing the Criteria for use (CFU).
- Complete and submit the Patient Enrollment Form (PEF) to the VA pharmacy at the same time. The VA pharmacy will review and fax the completed form to Walgreens Specialty Pharmacy. Reviews must be completed within 96 hours of the VA Pharmacy receiving a prescription.
†Available via a non-formulary request with criteria for use (CFU).
Customizable sample letters to help you navigate the coverage process
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WARNING: PERIPHERAL ISCHEMIA FOLLOWING COADMINISTRATION WITH STRONG CYP3A4 INHIBITORS
Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of dihydroergotamine with strong CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. Because CYP3A4 inhibition elevates the serum levels of dihydroergotamine, the risk for vasospasm leading to cerebral ischemia and/or ischemia of the extremities is increased. Hence, concomitant use of Brekiya with strong CYP3A4 inhibitors is contraindicated.
Brekiya is an ergotamine derivative indicated for the acute treatment of migraine with or without aura and the acute treatment of cluster headaches in adults.
Limitations of Use:
Brekiya is not indicated for the preventive treatment of migraine or for the management of hemiplegic migraine or migraine with brainstem aura.
- Concomitant use of strong CYP3A4 inhibitors.
- Ischemic heart disease or coronary artery vasospasm.
- Uncontrolled hypertension, peripheral arterial diseases, sepsis, following vascular surgery, or severe hepatic or renal impairment.
- Concomitant use of other 5-HT1 agonists, ergotamine-containing or ergot-type medications within 24 hours.
- Hypersensitivity to dihydroergotamine, ergot alkaloids, latex, or any of the ingredients in Brekiya.
- Concomitant use with peripheral and central vasoconstrictors.
- Myocardial Ischemia and/or Infarction, Other Cardiac Adverse Reactions, and Fatalities: In patients with risk factors predictive of coronary artery disease, consider first dose administration under medical supervision with an electrocardiogram.
- Cerebrovascular Adverse Reactions and Fatalities: Cerebrovascular hemorrhage, subarachnoid hemorrhage, and stroke have been reported; discontinue Brekiya if suspected.
- Other Vasospasm Related Adverse Reactions: Brekiya may cause vasospasm or elevation in blood pressure. Discontinue if signs or symptoms of vasoconstriction develop.
- Medication Overuse Headache: Detoxification may be necessary.
- Preterm Labor: Advise pregnant women of the risk.
- Fibrotic Complications: Pleural and retroperitoneal fibrosis have been reported following prolonged daily use of dihydroergotamine mesylate. Do not exceed the Brekiya dosing guidelines or use for chronic daily administration.
Serious cardiac events (including fatal) that have been reported with dihydroergotamine mesylate injection use include: coronary artery vasospasm, transient myocardial ischemia, myocardial infarction, ventricular tachycardia, ventricular fibrillation.
- For subcutaneous injection only.
- Recommended dosage is 1 mg administered subcutaneously as a single 1 mL autoinjector.
- Do not exceed 3 mg (3 doses) in a 24-hour period.
- Do not exceed 6 mg (6 doses) in a week.
- Prior to initiation, a cardiovascular evaluation is recommended.
- Beta Blockers/Nicotine: May potentiate/
provoke vasoconstriction. - Selective Serotonin Reuptake Inhibitors: Weakness, hyperreflexia, and incoordination may occur with coadministration.
- Pregnancy: Based on animal data, may cause fetal harm.
- Lactation: Advise not to use during breastfeeding and for 3 days after the last dose.
To report SUSPECTED ADVERSE REACTIONS, contact Amneal Global Patient Safety at 1-877-835-5472 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
Please see the Brekiya Full Prescribing Information, including Boxed Warning and Medication Guide.
Reference: 1. Brekiya [package insert]. Bridgewater, NJ: Amneal Pharmaceuticals LLC; 2025.
