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?