Korea migraine CGRP injection cost and coverage guide
This guide explains the drug cost, dose count, and South Korea National Health Insurance reimbursement checklist for preventive anti-CGRP monoclonal-antibody injections used in chronic migraine.
It covers Emgality (galcanezumab) once monthly, Ajovy (fremanezumab) once monthly, and Ajovy 675 mg once every three months.
The key distinction is between the MFDS-approved indication and HIRA reimbursement.
A medicine may be approved for migraine prevention but still be billed at 100% self-pay when the narrower Korean reimbursement criteria are not documented.
Korea-specific estimate verified July 19, 2026. Prices are HIRA benefit-ceiling figures effective July 1, 2026, and the checklist follows HIRA anti-CGRP antibody criteria.
This is educational planning information, not a diagnosis, prescription, hospital quote, or HIRA approval decision.
What CGRP antibody injections do
Migraine is a neurologic disorder that can cause disabling head pain, nausea, sensitivity to light or sound, and loss of work, school, household, or social activity.
Calcitonin gene-related peptide, abbreviated CGRP, participates in migraine signaling, and monoclonal antibodies that target the CGRP pathway are used as preventive treatment to reduce future migraine burden.
These injections are not rescue medicines for stopping an attack that is already under way.
Do not discontinue an acute-treatment plan or another preventive medicine solely because a cost result looks favorable; the prescribing clinician must decide treatment and transition timing.
Official July 2026 drug prices and regimens
The HIRA benefit list effective July 1, 2026 sets Emgality 120 mg at KRW 295,187 per pen or prefilled syringe and Ajovy 225 mg at KRW 295,086 per pen or prefilled syringe.
These are ceiling prices for the drug unit, not a complete outpatient invoice.
Comparison of Emgality and Ajovy dosing, unit prices, and units used over 12 months| Regimen | MFDS dosing used by the calculator | Unit price | 12-month units |
|---|
| Emgality monthly | 240 mg loading dose, then 120 mg monthly | KRW 295,187 | 13 |
| Ajovy monthly | 225 mg monthly | KRW 295,086 | 12 |
| Ajovy quarterly | 675 mg every three months as three consecutive 225 mg injections | KRW 295,086 | 12 |
The price source lists both syringe and pen presentations at the same ingredient-level amount shown above.
Consultation, injection administration, dispensing, tests, and unrelated covered or non-covered services are outside this drug-only estimate.
Initial HIRA reimbursement checklist
HIRA reimbursement for this use is built around documented adult chronic migraine, not merely a migraine diagnosis.
All of the following input conditions must be met for the calculator to mark an initial case as eligible.
- Age: 18 years or older.
- Migraine history: at least one year, represented as 12 months or more.
- Chronic pattern duration: at least six months before treatment.
- Monthly frequency: at least 15 headache days and at least 8 migraine days per month during that chronic period.
- Disability score: MIDAS 21 or higher, or HIT-6 60 or higher.
- Previous preventive treatment: failure of at least three qualifying drugs or drug groups.
Monthly headache days and monthly migraine days are related but not interchangeable.
The first count includes every headache day, while the second count identifies days with migraine features under the clinical record and headache diary.
What counts as failure of three preventive drugs?
The listed Korean criteria include topiramate, divalproex, amitriptyline, flunarizine, and a qualifying beta blocker.
For the beta-blocker category, the public criteria identify propranolol or nadolol; an unrelated beta blocker should not automatically be counted.
Failure is more specific than having tried a tablet briefly.
It generally means treatment at the maximum tolerated dose for at least eight weeks without a reduction of at least 50% in monthly migraine days, or inability to use the drug because of an adverse effect or contraindication.
Bring the drug name, dose, dates, response, adverse effects, and reason for stopping to the consultation.
The calculator accepts only a count from zero to five; it cannot verify whether each treatment record satisfies HIRA documentation rules.
Continuation review: the 50% rule
Baseline assessment should be documented within the month before treatment, and response is reviewed every three months using an objective headache diary and disability record.
Continued reimbursement requires at least a 50% reduction in monthly migraine days from baseline at each response review.
response rate (%) = (baseline monthly migraine days − current monthly migraine days) ÷ baseline monthly migraine days × 100
A baseline of 10 days and a current value of 4 days produces a 60% reduction and passes this numeric response check.
A baseline of 8 days and a current value of 4 days is exactly 50% and also passes, while 10 days falling to 6 days is only 40% and fails the continuation check.
The maximum reimbursed treatment period in the verified criteria is 12 months.
Preventive switching between anti-CGRP monoclonal antibodies is not reimbursed, so an approved indication does not guarantee covered switching from Emgality to Ajovy or the reverse.
Exact dose-count and cost formulas
Let M be the planned treatment months after clamping the input to one through 12.
The Korean calculator applies the following unit-count formulas.
Emgality monthly units = M + 1
Ajovy monthly units = M
Ajovy quarterly units = ceil(M ÷ 3) × 3
list drug cost = unit price × required units
covered patient cost = round(list drug cost × selected copay rate)
non-covered patient cost = list drug cost
The extra Emgality unit represents the first 240 mg loading dose, which needs two 120 mg units rather than one.
Ajovy quarterly uses all three 225 mg units on one dosing date, so a one-, two-, or three-month planning window still purchases one full 675 mg administration of three units.
Worked cost examples
Emgality, 12 months, eligible at 30%
Required units are 12 + 1 = 13.
List drug cost is KRW 295,187 × 13 = KRW 3,837,431, and the rounded 30% patient drug cost is KRW 1,151,229.
Ajovy monthly, 12 months, eligible at 30%
Required units are 12.
List drug cost is KRW 295,086 × 12 = KRW 3,541,032, and the rounded 30% patient drug cost is KRW 1,062,310.
Ajovy quarterly, first administration, eligible at 30%
One quarterly administration needs three units even in a one-month planning window.
List drug cost is KRW 295,086 × 3 = KRW 885,258, and the rounded 30% patient drug cost is KRW 265,577.
If any required coverage item fails, the same examples are displayed at 100% of the list drug cost rather than at 30%.
Actual billing can differ because the calculator omits consultation, testing, administration, dispensing, rounding, and other services.
Ordinary Korean outpatient copays used
National Health Insurance Act Article 44 establishes patient cost sharing, and Enforcement Decree Article 19 refers the detailed rates to Annex 2.
The calculator offers a simplified 30% pharmacy or clinic rate, 40% hospital rate, 50% general-hospital rate, and 60% tertiary-hospital outpatient rate.
In-hospital administration is the rule in the verified anti-CGRP reimbursement criteria.
After at least six months of stable administration without adverse effects, self-injection may be allowed following education, and no more than two doses may be prescribed at one time under that rule.
The selected percentage is not a promise that every line on the bill has that rate.
The provider type, place of dispensing, claim details, other benefits, and 100-won handling can change the final invoice.
How to use the Korean calculator accurately
- Select Emgality monthly, Ajovy monthly, or Ajovy quarterly; the official unit price is loaded automatically.
- Choose initial treatment or the three-month continuation review.
- Use a headache diary for age, history, chronic-pattern duration, total headache days, and migraine days.
- Select the score actually used in care, MIDAS or HIT-6, instead of trying to convert one score into the other.
- Count only qualifying preventive failures supported by dose, duration, response, adverse-effect, or contraindication records.
- For continuation, enter the baseline and current monthly migraine-day counts measured in a consistent way.
- Set one through 12 treatment months and the likely provider copay category, then review unmet items before reviewing price.
Numeric fields preserve an editable draft until the user leaves the field, which prevents a partially deleted value from jumping immediately to a minimum or maximum.
The committed value is then rounded and kept inside the documented safety range.
How to interpret the result
A green result means only that every numeric input condition in the public checklist passed.
The calculator cannot confirm ICHD-3 diagnosis, maximum tolerated dose, eight-week treatment documentation, contraindications, diary quality, timing of baseline records, or HIRA adjudication.
An amber result is not a medical conclusion that treatment cannot be used.
It means the entered scenario is priced as 100% self-pay and the unmet documentation should be reviewed with a neurologist or the treating institution.
The cost per reduced migraine day is a personal planning ratio calculated from the user-entered baseline and current diary values.
It does not insert an average clinical-trial effect, predict future response, or compare medical efficacy between the regimens.
The annual out-of-pocket ceiling is not automatically deducted because it depends on all covered patient cost sharing in the calendar year and the applicable income tier.
Private indemnity reimbursement is also omitted because policy generation, outpatient deductibles, limits, and exclusions vary.
Safety, storage, and urgent symptoms
Injection-site reactions can occur, and serious hypersensitivity including anaphylaxis or angioedema is a medical emergency.
Seek urgent help for breathing difficulty, swelling of the face, lips, or tongue, or widespread hives after injection.
The MFDS Emgality label specifies refrigerated storage at 2–8°C, protection from light, no freezing or shaking, and up to seven days outside refrigeration at no more than 30°C.
Once stored at room temperature under that instruction, it should not be returned to the refrigerator; always follow the exact leaflet for the product and presentation actually dispensed.
Discuss pregnancy, breastfeeding, pregnancy planning, previous biologic hypersensitivity, and other medical conditions before treatment.
A sudden worst-ever headache, new weakness or speech trouble, altered consciousness, fever with neck stiffness, or severe post-traumatic headache needs urgent medical assessment, not a cost calculation.
Frequently asked questions
Why does the first Emgality month cost more?
The loading dose is 240 mg, so it uses two 120 mg units on the first dosing date.
Maintenance is one 120 mg unit monthly, which makes 13 units over a 12-month course.
Do monthly and quarterly Ajovy have the same annual drug cost?
At the same unit price, both use twelve 225 mg units over a complete 12-month period.
The difference is the dosing schedule and cash-flow timing: monthly uses one unit at a time, while quarterly uses three together.
Do 15 headache days alone qualify?
No.
The verified reimbursement checklist requires both at least 15 monthly headache days and at least 8 monthly migraine days for at least six months, plus all other criteria.
Can HIT-6 qualify when MIDAS is below 21?
The public threshold is MIDAS 21 or higher or HIT-6 60 or higher.
Enter the assessment actually documented in care; the calculator does not convert one instrument into the other.
Can anyone self-inject after six months?
No.
Stable treatment, absence of adverse effects, training, and the clinician’s judgment are required, and the verified reimbursement rule limits one prescription to two doses.
Does covered switching continue from Emgality to Ajovy?
The verified criteria do not reimburse switching between preventive anti-CGRP monoclonal antibodies.
Confirm the latest notice and expected full cost before any clinically directed switch.
Is the annual out-of-pocket ceiling already deducted?
No.
The ceiling depends on all covered patient cost sharing in the calendar year and the applicable income tier, so this drug-only calculator does not guess a refund from one prescription stream.
Official sources and update triggers
- HIRA galcanezumab reimbursement criteria under Notice No. 2024-130, effective July 1, 2024, plus HIRA criteria material covering fremanezumab.
- HIRA List of Reimbursed Drugs and Ceiling Prices effective July 1, 2026, mirrored by the Korea Health Industry Development Institute.
- MFDS NEDrug product information for Emgality, item sequence 201906308, and Ajovy prefilled syringe, item sequence 202105577.
- National Health Insurance Act Article 44, Enforcement Decree Article 19 and Annex 2, and the Rule on Standards for National Health Insurance Medical Benefits Article 5, current through July 19, 2026.
Recheck the page when the unit prices, age or migraine-frequency thresholds, failed-preventive list, response percentage, 12-month limit, switching restriction, self-injection rule, or Korean outpatient copays change.
Additional reimbursed CGRP antibodies must be added only after current MFDS and HIRA status is verified.
Use documented diary values, then confirm with the treating team
Recalculate with the actual monthly headache and migraine-day counts, disability score, and preventive-treatment record.
Take the unmet checklist and dose-budget comparison to the neurology consultation; the clinician, provider, and latest HIRA rule remain authoritative.