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 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 file the initial claim, and handle additional paperwork at any step of the process, including:
- Prior Authorizations
- Letters of Medical Necessity or Exception
- Appeals, if the initial claim is denied
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
For patients who have a denied prior authorization, and an appeal is pending, they may qualify for the Head Start Program to receive Brekiya autoinjector at no cost until a final coverage decision is rendered. Eligible patients will receive a maximum of 3 cartons (4 single-dose autoinjectors per carton), within a consecutive 90-day period.
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.
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 autoinjector with strong CYP3A4 inhibitors is contraindicated.
Brekiya autoinjector is contraindicated in patients:
- With concomitant use of strong CYP3A4 inhibitors; with peripheral and central vasoconstrictors; and with other 5-HT1 agonists, ergotamine-containing or ergot-type medications within 24 hours.
- With ischemic heart disease or coronary artery vasospasm.
- With uncontrolled hypertension, peripheral arterial diseases, sepsis, following vascular surgery, or severe hepatic or renal impairment.
- Who have hypersensitivity to dihydroergotamine, ergot alkaloids, latex, or any of the ingredients in Brekiya autoinjector.
- 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 autoinjector if suspected.
- Other Vasospasm Related Adverse Reactions: Brekiya autoinjector 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 autoinjector 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 patients not to breastfeed during treatment with Brekiya autoinjector and for 3 days after the last dose.
Brekiya autoinjector is indicated for the acute treatment of migraine with or without aura and the acute treatment of cluster headaches in adults.
Limitations of Use:
Brekiya autoinjector is not indicated for the preventive treatment of migraine or for the management of hemiplegic migraine or migraine with brainstem aura.
Reference: 1. Brekiya [package insert]. Bridgewater, NJ: Amneal Pharmaceuticals LLC; 2025.
