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Aimovig Insurance Coverage: Will Insurance Cover Amgen’s New Migraine Prevention Drug?

Do insurance companies offer Aimovig insurance coverage?

Depending on the insurance company, Aimovig insurance coverage could already be available! Some readers have reported success with getting insurance coverage already. 

My insurance company told me Aimovig came out too late to be included on their current formulary, which is updated twice a year. I was told they’ll make a determination for the January 2019 or July 2019 formulary. As a fellow advocate pointed out, if this were a cancer drug, insurance companies would be unlikely to tell patients they have to wait six months to a year to learn if it will be covered. If I decide to continue with Aimovig after the free trial, I will actively pursue coverage, which will certainly involve letters from my doctor and insurance appeals. I’ll let you know how it goes.

If it’s not available yet, will Aimovig insurance coverage eventually be available?

The likelihood that insurance companies will cover Aimovig and other CGRP-inhibitors is promising. ICER, the organization that insurance companies look to for guidance, issued a report on May 31, 2018 that CGRP-inhibitors are a cost-effective treatment for both episodic migraine and chronic migraine. The migraine advocacy community was pleasantly surprised by this news and is hopeful that it bodes well for coverage. ICER has yet to make its final determination and insurance companies are free to make their own decisions no matter what ICER determines, but we’re in better shape than expected at this point.

The bottom line? Check with your insurance provider now to see what their policy is and, if they aren’t covering it yet, when they plan to make a decision. (And know it’s worth going through the appeals process even if they say they don’t cover it yet. If nothing else, if you have commercial insurance, that will make you eligible for Amgen’s Bridge to Commercial coverage program.)

Will Medicare and Medicaid cover Aimovig?

Probably yes, eventually. I know that’s a lot of equivocation! Medicare and Medicaid are usually slower to adopt medication coverage than commercial insurance companies are. The ICER report could work in our favor though, especially if it’s considered more cost-effective than Botox, which Medicare and Medicaid do cover.

Patience and Optimism

Advising people to be patient is tough—we’ve already waited so long for the first CGRP drug to become available. Though I do think coverage will come sooner than we might expect. I can’t overstate how important it is that ICER’s report determined that CGRP-inhibitors are cost-effective for people with chronic migraine and those with episodic migraine. Combined with Amgen’s two-month free trial and Bridge to Commercial Coverage program I wrote about yesterday, people with commercial insurance have a promising outlook.

Unfortunately, I know many of you have state or federal insurance, which doesn’t benefit from these programs. The disparities in access to medical treatments makes me sick. If you have Medicare Part D, you may be available for coverage through the Amgen Safety Net Foundation

How about you? Do you have Aimovig insurance coverage? Please leave a comment and let us know what your experience has been like?

23 Responses to Aimovig Insurance Coverage: Will Insurance Cover Amgen’s New Migraine Prevention Drug?

  1. Kathleen says:

    I get daily migraines. I am 79 and have had a stroke. Is this a drug I can take?

  2. Timothy Bauer says:

    Thanks for all the info Kerrie!!!

    Timothy Bauer
    Reno, Nevada

  3. Debbie Bryant says:

    Do you know if Arkansas medicaid patients will be covered for aimovig treatment?

  4. Melissa Hope says:

    I’m a 36 year old mother of 3, I’ve had Pseudotumor Cerebri for 10 years. I am a shunt dependent patient.(currently I have both a VP shunt and my 2nd LP shunt. 4 surgeries, 11 spinal taps) Doctors think that I also have migraine and one disorder triggers the other. I’ve been on Topamax, Diamox, Nortriptyline, Gabapentin, Metoprolol, and Effexor XR.
    Current rescue meds include Fioricet, Imatrex, and Migrainal nasal spray.
    Aimovig sounds like it would be a life saver. However, Fidelis/Medicaid won’t cover it at this time. I would love to be in a trial for the med, I am a pretty interesting medical case.

  5. Theresa Tripp says:

    I have any where from 6+ migraines monthly my insurance doesn’t cover this, I have tried everything just need relief

  6. Michele Williams says:

    Kathleen – I too get daily migraines & presently take Relpax (over $1000. monthly) thanks to good pension). I taught high school Eng. & did 3 shows a year on stronger meds. that were less & less good for me. AIMOVIG is the end of the line as I need to help a vibrant 99 year old mom and help with babysitting & am tired of over 45 years headaches. My neurologist may be able to override some cost – 2019 should improve. Kerrie, thanks for your help – my mother thanks you, my in heaven father thanks you, my husband thanks you, AND I THANK YOU.
    Peace

  7. Omar Cavazos says:

    I just checked with my local pharmacy (Walmart) and they don’t carry it. (Louisiana). Tho, even if they did, There’s no way I can cough up the $620 with my Social Security Disability monthly allotment. I’m desperate for relief. Migraines daily and I take Imitrex injections, Maxalt, Fiorecet, Hydrocodone and Botox every 3 months. I don’t go anywhere because I’m confined between my walls. My quality of life is practically gone and I’m not quite 60 yet.

  8. Donna L Price says:

    Aimovig I was qualified for the medicine the pharmacist had called I didn’t get that I didn’t pick up the call in time and I had called back to tell him to leave the medicine on a Friday that’s been 3 weeks ago I have still not heard nothing back from the company or the pharmacist just kind of wondering when my medicine was going to be delivered because I had done went through the patient program for the free trials my name is Donna price

  9. Cindy says:

    Will Tricare for life ever cover Aimovig?

  10. Corrine says:

    So my doctor signed me up for the free trial as soon as the program started, since it would allow me to get the Aimovig a month before Kaiser pharmacies had it. Well Amgen approved me right away and the medication was supposed to arrive two weeks later. When it did not arrive my doctor contacted the company who said they had received far more applicants than expected and the medication should arrive in four weeks rather than two weeks. Well that was over two months ago and I never did receive the free trial.
    I have Kaiser and THREE times now I have been written a prescription, then as the medicine is being shipped to my local Kaiser pharmacy, Kaiser suddenly changed its requirements and said I was no longer eligible to receive the medication. It was one thing after another–blood tests and pregnancy tests, questionnaires, migraine diaries, and a whole list of other eligibility requirements that morphed and grew from one day to the next. I’ve now been told with finality that I do not qualify and that the migraine specialist is being told she can no longer even see me since I live out of the area. Absolutely ridiculous!!! I don’t know what to do!!!
    Has anyone else had a similar experience?

  11. Marie W. says:

    I’m on the free trial, but would love to know if tricare for life will cover the drug..it is wonderful and went from 6+ migraines a month to 1 or 2 the first month after the injection.

    • Hi Marie, you’ll need to contact your insurance company to see. If they don’t, call the Aimovig Ally program–they have a bridge to commercial coverage, which will cover up to 12 months of the medication while you’re trying to get coverage. They may also have strategies for an insurance appeal.

      Take care,
      Kerrie

  12. D Zusman says:

    Carefist Federal – our insurer (covers government employees) – is not covering Aimovig.

  13. Laura says:

    I tried my first shot and was so excited after daily migraines for 10 years and every medicine under the sun including Botox all don’t work.

    The day after the shot I had the worst migraine and felt like someone hit me in the stomach with a baseball bat and my ears are all plugged up. A week later I am still a mess!
    Now my neurologist is putting me on prednisone for 3 days and told me to try Aimovig again next month!
    I just don’t understand why these migraines continue to be so severe every day?

  14. Corrine says:

    Don’t give up! My doctor said you won’t see improvement the first week. It becomes more effective each week, with full benefit at about the 4th week. I had a long stretch there with no migraines. I mean, it’s not the magic pill, I’ve given up on that fantasy! I use a multi-faceted approach these days–my botox every 3 months with an occipital nerve block at the same time. I recently began using CBD oil daily. It really gives me a sense of calm. When my migraines are at their very worst, especially if I’m nauseous or can not stop throwing up, I will take a puff on my marijuana pipe or I do what’s called microdosing. I buy gummy candies that only have 6 mg of THC in them (and that is a TINY amount!) and I often don’t even eat the whole gummy. It gives me the benefit of the THC without the mind altering side effects. Medical marijuana and CBD oil are really worth trying. As are essential oils. I’ve only had 2 doses of Aimovig (as was the program) and have missed getting another dose. But great news, they have a new program called the aimovig ally access card. Check it out: aimovigallyaccesscard.com. Call their number and speak to a real person, they will get you the medication. I get 12 months of aimovig for five bucks copay! If you don’t have the Headache Hat (Amazon), it is a MUST!!! I think what’s helping me the most is that I’m not working. I have good days and bad days. I go into migraine land for days on end then emerge hungry and to a messy house. Hang in there. If you can take some time off work (migraine IS considered a disability), it really helps. Oh! And I found that cutting out sugar (not super hard core, but just trying to avoid it for the most part) is a biggie for me. Have you been feeling any better lately?

  15. Maria Kilgore says:

    Is this covered by Tricare for life?

  16. Jen says:

    Good Day,
    My insurance is Sav-rx. They won’t cover it. My Dr wanted me to move on to this drug as I still get the migraines often. Is there anything out there that discounts this for patients? Thanks

  17. Registered Nurse says:

    Aimovig Support will deny any application without prior arthorization by Medicare Part D; Medicare Part D is hardly going to put in writing that Aimovig is medically indicated for a patient, but Medicare refuses to pay! Aimovig did not research the effectiveness among patients over age 65 years, but by including a single research subject over age 64 years the company managed a broad approval not awarded in EU. Now, Aimovig hope to marshall support from senior citizens by shifting the blame for inability to continue with an effective medication to Medicare: hoping hundreds of senior citizens will push phyysicians and Medicare Part D insurers to create implied approval for Aimovig, based on anecdotal case reports, some by patients hoping for effectiveness for a medication with up to three months delay in acting. Aimovig hopes patients will pay $700. for the possibility a third dose will reduce migraine headaches, unaware Aimovig Support will not be providing financial support to those in need who are unable to force Medicare Part D to write Aimovig is medically indicated and refused. Medicare Part D should issue a prior athorization for Aimovig for individuals over 65 years who wish to receive Aimovig for the purpose of initiating research on senior citizens!

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