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How to Pay for Aimovig, Amgen’s New Migraine Prevention Drug

How to pay for Aimovig? Will insurance cover it? How am I paying for my first dose? These are the questions I got when I posted the delivery date of my Aimovig to Facebook. My insurance isn’t covering it yet (though some insurance companies are), but I’m not paying for it either. My first two doses are coming free through Amgen’s two-month free-trial. If my insurance won’t cover it after that, Amgen will pay for up to another 12 months of doses while I go through the insurance appeal process. Those are two of Amgen’s four programs to help pay for Aimovig, only one of which requires demonstrated financial need. This post describes those four options. Tomorrow I’ll talk about insurance coverage, which is looking quite promising for patients with commercial coverage. [Update: Aimovig Insurance Coverage: Will Insurance Cover Amgen’s New Migraine Prevention Drug?]

Note: You may be eligible for several different programs, so be sure to read through all the options.

My knowledge on these programs is limited to what I’ve shared here. If you have questions, please call Aimovig Ally at (833) 246-6844. I found their customer service incredibly helpful and responsive. And I’d love if you leave a comment sharing what you learn so we can all know more about the programs!

How to Pay for Aimovig, #1: Two-Month Aimovig Free Trial

The two-month free trial is available to all new Aimovig patients (except those who live in Massachusetts or have participated in a clinical trial). Participants will receive two months of Aimovig (either 70 mg or 140 mg each month, depending on what your doctor prescribes) at no charge. There is no continuing obligation. You must enroll by Dec. 31, 2018. See page 4 of this Aimovig prescription form for the legalese.

(My first doses are through the two-month free trial. It was super-easy. I filled out the paperwork through my doctor, who submitted it to the Aimovig Ally pharmacy. The pharmacy called me about a week later to arrange delivery. A nurse also called to offer injection training—she’ll be on hand for my first injection to show me exactly what to do. I have heard some people in other parts of the country have waited weeks with no call from the partner pharmacy—I suspect that distribution facilities in different regions have differing supply levels or responsiveness.)

How to Pay for Aimovig, #2: Up to One Year of Free Aimovig While Waiting for Insurance Approval

The “Bridge to Commercial Coverage” program provides up to 12 months free to patients while they are pursuing insurance coverage. To qualify, you must have commercial insurance (state or federal coverage, like Medicare or Medicaid, don’t qualify) and your insurance company has to have denied your request to cover Aimovig or not cover it at all. You also need a valid prescription for Aimovig and have tried at least one other preventive without success. You must enroll by Dec. 31, 2018. Massachusetts residents are not eligible for the program.

This program requires that you (and your doctor, if necessary) are actively pursuing insurance coverage and appealing denials while you’re receiving the free doses. Page 4 of the Aimovig prescription form has details about the paperwork that might be required.

How to Pay for Aimovig, #3: Aimovig Copay Support

Patients with commercial insurance can reduce out-of-pocket costs to as little as $5 per month (with a $2,700 annual maximum savings). Eligibility is not based on income. Since the details of this program may change, please see Amgen’s Aimovig copay support information for specifics. You cannot use copay support if you have state or federal coverage, like Medicare or Medicaid.

How to Pay for Aimovig, #4: Prescription Assistance for Those with Demonstrated Financial Need

Here’s the wording of the program directly from Amgen since I don’t have firsthand experience with it.

“You may be able to receive Aimovig™ at no cost from Amgen Safety Net Foundation if you meet the following eligibility requirements:

  • Resident of the United States or its territories
  • Those in one of the following insurance situations:

o Uninsured

o Patient’s Insurance Plan excludes the Amgen product

  • Patient demonstrates a financial need: Income at or below 500% of the federal poverty limit (FPL) [According to the Amgen Safety Net Foundation website on June 12, 2018, that’s currently $60,700 for a household of one; $82,300 for a household of two; $103,900 for a household of three; $125,500 for a household of four; and an additional $21,600 for each additional person.] 
  • Certain standard Medicare Part D patients with product coverage that cannot afford their out-of-pocket costs may be eligible. These patients must:

o Meet additional financial criteria demonstrating their inability to afford the product

o Not be eligible for Medicaid or Medicare’s low-income subsidy (LIS)

o Satisfy all payer guidelines and prior authorization (PA) requirements prior to applying for assistance

o Not have any other financial support options”

You can learn more at the Amgen Safety Net Foundation website and on the Aimovig prescription form.

What’s been your experience determining how to pay for Aimovig? Please share your story in the comments.

27 Responses to How to Pay for Aimovig, Amgen’s New Migraine Prevention Drug

  1. Kate says:

    Thanks Kerrie for gathering all this helpful info! Its way more detailed than I’ve found anywhere else. Good to see that the manufacturer has so much patient assistance. I was surprised to find my insurance covers this (I assumed it would take them longer to add to the system), although of course they require a prior authorization.

    I found a sample prior auth form online and it appears they check for (a chronic migraine diagnosis, patient not having anything contraindicated for med, having failed or not tolerated 2 preventatives in 2 classes, is not getting Botox, is not on another CGRP, is not considered to be in rebound, is seeing a headache specialist, and correct med dose per label), then approve for 3 months, then if the same criteria are still met plus they have seen measurable success, they approve for 12 months. The seeing a headache specialist part was the most interesting. This criteria will likely vary slightly by insurance company though.

    I’m going to my neuro later this week to ask about it, so hopefully I can get a prescription, the prior auth gets approved, my pharmacy can order it, and the manufacturer’s copay card reduces it to $5.

    I figured its not really worth doing the extra work for the 2 free months if it would be only $5 and I’d have to go through more paperwork/waiting/etc after those 2 months anyways. As long as I tolerate it (seems very likely given the low side effect profile), I’m game to give it a long trial, despite it being reported to have a quick effect, as I have NDPH not migraine, and there seems to be some evidence that we are slower to respond to treatments, and might as well. Very exciting times!

    • Thanks for sharing your experience, Kate. I hope it provides you with relief! Please keep us updated on how it goes. My fingers are crossed that it helps for NDPH, which would be amazing.

      The two free months took me about 10 minutes of work. It’s the form that I link to, which your doctor has to sign and send in. Then the pharmacy will call you to arrange delivery. The most complicated part (for me) is that it has to be signed for, so a person has to be present for delivery and to put it in the refrigerator. I’ve heard other patients have had more trouble–perhaps it’s a regional thing?–but if you have the time for the form, it might be worth having your doctor submit it at the same time as you start the prior authorization process.

      Take care,
      Kerrie

    • Laura says:

      Kate- Was it your own insurance company that requires you not be on Botox? Does the bridge plan for 12 months require you to be off Botox? I am currently on Botox but still get 15 headaches per month. I don’t know what it would be like off of Botox so I don’t really know if it helps. I got my first Aimovig injection a week and half ago and I think it already has started working. I got warning signs for migraine and/or very very mild migraines that my abortative med relpax (almost always works) did not help. However, they did not turn into full blown migraines and each time went away with sleep. That NEVER happens. Does anyone know definitively how soon Aimovig begins to work? I heard as soon as 6 days from one provider and 2-4 weeks from a different provider.
      Laura

  2. Laurel Sutton says:

    Thanks for the information! I was in a clinical trial for this drug and it was amazing – but I believe that disqualifies me for the 2-month trial. I have Kaiser in CA for health insurance and I checked with my neurologist, who said that they don’t have access to it now, but to check back in 6 months. Fingers crossed they can get it for me!

    • Laurel, I’m so happy the clinical trial was helpful for you! What was it like for you?

      You might want to look into Amgen’s Bridge to Commercial Coverage program. They’ll cover up to 12 months of doses while you’re waiting for insurance approval. I believe they’ll mail the doses directly to you (as long as your doctor prescribes it).

      Take care,
      Kerrie

      • Laurel A Sutton says:

        Kerrie, the trial was really good. The injections are not painful at all – the needle is very small (like an insulin needle) and I had no side effects from it. It took a couple of months for the full effects to manifest; the frequency of my migraines went down steadily (starting from 10-15 a month) and by 3 months into the trial I was down to 1-2 migraines a month, and even those were very mild. The best part was that the effects lingered even after the trial was done. I will definitely look into Amgen’s Bridge to see if I qualify.
        I often wake up with migraines and the pain is usually around a 4; but the nausea is awful and nothing really helps (except promethazine, which puts me to sleep). The Aimovig worked very well for me on both pain and nausea, which was a delight. The clinic where I did the trial said that almost all of the patients in the trial had good results.
        Thank you again for all the detailed information! You’re a treasure!

  3. Kate says:

    Laura,

    The prior authorization process I found online for my insurance (Blue Cross) had a criteria about not having received Botox in the last 4 months (and not planning to receive it after starting Aimovig).

    I didn’t see anything about Botox in the bridge program info ( http://www.thedailyheadache.com/wp-content/uploads/2018/06/Aimovig-prescription-form.pdf ), nor in the full Aimovig prescribing info ( https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/761077s000lbl.pdf ), but I read they didn’t study any of the meds in this class in patients currently on Botox (that was an exclusion criteria from the trial).

    From the Aimovig prescribing info, a chart (Figure 1 on page 8) shows the headache days per month reduction begins right away (< 1 month), but the full effect (leveling off of the reduction in number of headache days per month) was not until 3 months in. That could account for the discrepancies in the answers you were given. Best wishes.

  4. claire Piper says:

    I’m excited and hopeful I’ll be able to get this. Medicare Part D covers very little, I have to get my triptans from Canada. Not an option with aimovig. I was in a 15 month trial of Teva’s CGRP, it was incredible, felt like I had my life back…for awhile.
    I couldn’t find anyplace to mail the forms, I have everything filled out and all my doctor’s stuff signed, but no mailing address. Fax only. I don’t have a fax or landline.

    • Kate says:

      Claire – You can ask your doctor’s office to fax them. Or, find another free place to fax them (maybe a library). Or, find a place to fax them at a small cost (like an independent shipping/copying type place). You might call ahead to ask if they have a fax though, as that seems to be getting more rare to find outside the medical industry.

  5. Laura says:

    Kate
    Thank you for the information. I believe that people on all preventative drugs (not just Botox) were excluded from the studies, as I had looked into joining one. That is super unfortunate that your insurance company will not pay for Aimovig if you are on another preventative such as Botox. Many people may be helped somewhat by Botox but not be able to tolerate other preventative oral meds and Aimovig may help them. The two doctors I spoke with had different understandings specifically of when Aimovig begins to work. One said 6 days the other 2-4 weeks. They both share an understanding that the full effect is seen at 2-3 months. In addition, I was told there were even higher response rates and some people who got two injections (total of 140) had a better outcome than those receiving a single injection of 70.
    Laura

    • Kate says:

      It is only in combination with Botox that the prior authorization criteria for my insurance excluded Aimovig coverage for. I am guessing they did it just because they could justify doing so (as it wasn’t studied), as Botox and Aimovig are probably the two most expensive preventative options by far.

      The Botox being excluded thing won’t be an issue for me though as I’m not on it. I tried it once way long ago with no response (for NDPH, at that time I didn’t get migraines), before they even said to try it 3 times. So, more recently I tried it twice, and it made my NDPH constant headache worse, especially the second time (2-3 months). With the more recent trial it was awesome for the migraines (I went from 2-3 per week to only 1 in the entire 3 months), so I was quite disappointed. I am on several oral daily meds and several oral as needed meds though.

      My insurance appears to covers the 2*70=140 dosage, if it is prescribed. As it was actually studied that way, it is hopeful that most insurance companies will. I’m curious if doctors will typically initially prescribe 70 or 140, and if 70, how many will try 140 if 70 was well tolerated. I’m actually not even sure what dose my doctor prescribed, I didn’t ask. I’m surprised if 140 worked slightly better and only had slightly more side effects why they didn’t just make that the recommended dose? Maybe because they can charge twice as much for 2 of the 70 injections? And unlike most meds they didn’t even bother making a 140 dose, they just say to do 2 shots.

  6. Laura says:

    Botox plus Aimovig may not have been “studied when taken together” . However, neither has Aimovig plus any other preventative. The insurance company not covering Aimovig if someone also is helped (but not fully) by Botox is not ethical. Yes, it is likely due to the cost factor. Hopefully that won’t be the case with most other insurances.
    Laura

  7. Laura Palka says:

    My neurologist is settling up the 2-month trial but I’m not sure it’s worth it if I can’t qualify for future patient assistance. I’m confused about their parameters. I don’t have commercial insurance. But I have Medicare Parts A & B, but not Part D. I don’t qualify for Medicaid. I also don’t know how to calculate being 500% below the federal poverty limit. Any help on my specific situation would be appreciated! By the way excellent article! Well researched and well written. Thanks!

    • Hi Laura, please call Aimovig Ally for specifics. They’ll be able to answer questions about Medicare and the programs you qualify for. You can also look at the Amgen Safety Net Foundation website for details on the federal poverty limit (on June 12, 2018, the site listed it at $60,700 for a household of one; $82,300 for a household of two; $103,900 for a household of three; $125,500 for a household of four; and an additional $21,600 for each additional person). I hope you’re able to find a program that works for you.

      Take care,
      Kerrie

  8. Laura says:

    Laurel
    I am 3 weeks into my first Aimovig shot. No reduction yet in migraine frequency but some of the migraines are more mild, and also harder to treat with my relpax. Does this mean I am not a responder or do I need to give it more time? I expected the frequency of migraines to be reduced in the first two weeks if I am responder.

    • Hi Laura, it hasn’t been tested on enough people to really know how long it takes to see an impact, but it can take a few months for the full effects to show up. And if you took 70 mg (one injection), you might want to talk to your doctor about taking 140 mg next time. You might have a better response with the higher dose. (My headache specialist says he will prescribe 140 mg almost exclusively as people tend to have better results with the higher dose without having more side effects.) I personally plan to do at least three months of shots unless I have a terrible reaction to them.

      Take care,
      Kerrie

  9. Laura says:

    Kerrie- I agree as I looked at the data and there is a better response with 140mg, not much, but with chronic migraine anything helps. However, it’s interesting as in contrast my neurologist said last week there was not much response difference between 70mg and 140mg so she was not impressed with prescribing the higher dose. She is not worried about these drugs short term. However, she also told me there is lots of chatter going on online between neurologists about potential long term safety of these new drugs. She said studies in mice have shown bone loss, high blood pressure and all sorts of issues. They are also worried about stroke and heart attack as CGRP is protective in that arena.

    • Thanks for the information, Laura. It’s funny how different doctors can read the data and come to completely different conclusions. I don’t think anyone is right or wrong (it’s too early to have any certainty), but everyone is doing what they think is best based on the research. I hope my earlier reply didn’t sound dismissive–I, too, am concerned about the unknown long-term effects of using Aimovig. CGRP is a useful protein in the body that has never been blocked before, so we have no idea what the long-term effects are. There could be no long-term problems or long-term issues in a number of areas. It’s all speculation right now, though it’s important to think about. Given all this, I’m nervous about trying it for myself, but I still think I’m going to try it.

      Please keep us posted on how you do in time. I’m sending you best wishes for relief.

      Take care,
      Kerrie

  10. Laura says:

    Also, wanted to add my doctor told me that in total the new CGRP drugs (not just Aimovig) have been tested on 10,000.

  11. Laura says:

    Yes completely agree with you. Ask different doctors and will likely receive different recommendations and each have different interpretations. I am really crossing my fingers this medication will be helpful as I am unable to tolerate other preventatives or they don’t work. I am not worried about the short term effects at all and to be frank the other drugs also can have some scary long term effects.

  12. Paul Woolley says:

    Thank you for sharing

  13. Jennifef says:

    Can you take botox and aimovig both? I have Hemicrania continuia so had some sort of headache everyday. Botox decreased the intensity but not to. 0. I stay around 4 on pain scale..

  14. Rebecca Gundolf says:

    I am a 67 yr old woman who has suffered from migraines since age 7. My mother, her two sisters and my grandmother, 2 brothers and a niece all suffer. I have been to 4 headache clinics with very little success. The neurologist in my city would not treat me because he said if the clinics couldn’t help neither could he. I have always used my family dr because of this. Would this make me ineligible for these program? I now use Sumatriptan injections and DHE45 injections to get rid of my headaches. I still suffer 8 to 10 migraines per month. There is no way I could afford to use Sumatritan and Aimovig if I had a breakthrough headache. My ins is Medigold. The Sumatriptan copy puts me in the Medicare donut hole by June each year. Is there any help for me?

    • Hi Rebecca, I don’t know the answers to your questions, but I’m sure people at the Aimovig Ally program can answer them for you. Their number is (833) 246-6844. I hope they’re able to find a program that works for you. Best of luck finding relief.

      Take care,
      Kerrie

  15. Kate says:

    Jennifer – About Botox + Aimovig: They were not studied together (ie. for the Aimovig study they excluded people who had recently had Botox), but that doesn’t mean they are necessarily contraindicated. However, I read my insurance’s prior authorization policy for Aimovig, and they exclude coverage for folks who had received Botox within 4 months or plan to after starting Aimovig. I’m guessing just because they could (as it wasn’t studied / was specifically excluded). Just a heads up in case your insurance also does that. Best wishes.

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