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?
28 thoughts on “Aimovig Insurance Coverage: Will Insurance Cover Amgen’s New Migraine Prevention Drug?”
Hi Kerrie, I just started Aimovig and immediately noticed an increase in histamine in my system. ALL of my histamine related symptoms got worse, including headaches 🙁 So I would caution anyone who knows that histamine is a trigger for them to be careful with Aimovig
Have you had any progress on getting Aimovig covered? I’ve been on it since July 2018 and am near the end of my insurance appeals (working on the next stage – appeal to the state – now). I have been a super-responder with only 3 bad migraines over 14 mos on Aimovig after 13+/month prior (and over a decade of this as with chronic migraine). I have been on the bridge program. I am also on Botox, which seems to be the biggest insurance issue. I tried stopping Botox, but I was back to daily migraines for 3 miserable months. Would love an update!
Hi Lori, I’m thrilled that Aimovig has been so helpful for you! I don’t use Aimovig, or any CGRP meds, so I haven’t done the insurance fight. You may want to contact the Patient Advocate Foundation. The organization’s website has a lot of helpful information on insurance appeals and they have a Migraine CareLine where a case manager can help you with getting insurance coverage: https://www.patientadvocate.org/migrainematters/ and https://patientadvocate.qualtrics.com/jfe/form/SV_8FUlsXddY13Izxr
After 2 denials, I just got approved for coverage for Ajovy. I am on Medicare Part D and MVP. I was scheduled for a hearing with an Administrative Law Judge with the department of Health and Human Services, but was granted approval by the Judge after she read all the material I sent in. What is crucial to getting what is called an “formulary exception” approved, is that your prescriber address each of the meds on the formulary and say why each one would either not be effective for you or would cause negative side effects, and state what ones you have tried and what was wrong with them. My prescriber did not do that, though the denials specifically told him that was why it was denied. It all hinged on him. I got legal help from someone who had a grant to address health care coverage problems and she sent a legal form all written out for him to just fill in the blanks. He did that, and it worked! If you are denied coverage, definitely keep appealing it.
Omar, I get migraines almost daily too. I am not yet 60 and have no life either. Aimovig is my last hope. It does seem to be working. I did their 2 month free trial, had a couple samples from my neurologist and now am forking over the huge insurance price for it. Still get the migraines, nausea, etc., but I am UPRIGHT and FUNCTIONAL (to a degree) whereas before, it was always straight to bed.
I also highly recommend the earplugs from Migrainex or now Weatherx I think is their new name (they’re lavender). Most of my migraines are barometric pressure based and seeing you were in LA. I thought some of yours might be whether you know it or not. They cost like $15 on Amazon. I seem to have one very sensitive ear that feels the pressure waves (after studying this daily, almost hourly, I can tell you within 5 minutes of when it’s going to rain and how hard), so I wear ONE earplug almost daily. The second only for severe weather. High pressure brings relief.
Other than that I also use the Cefaly machine — kinda a TENS machine for your forehead. It costs about $250.00 initially and then you need to keep buying pads. It does help significantly. (For me, the earplugs help more.) And, of course, they’re all the bandaids I throw at it too: Forinal, Excedrin migraine formula, Sudafed, and Nasinex.
Good luck to you and whoever reads this comment. (I have Hashimoto’s Disease, Chronic Back Pain, Fibromyalgia, PTSD and it looks like Rheumatoid Arthritis — I find out on the 13th — so I know life can be hard, but it’s always better when keeping positive and a sense of humor. Studies have shown people who believe in a higher power do better in the long run. Sorry Atheists.
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!
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
Hi Jen, I recommend calling the Aimovig Ally support line. They should be able to answer your questions.
Is this covered by Tricare for life?
Hi Maria, you’ll have to call your insurance company to find out. I hope it’s covered for you!
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?
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?
Carefist Federal – our insurer (covers government employees) – is not covering Aimovig.
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.
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?
Will Tricare for life ever cover Aimovig?
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
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.
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.
I have any where from 6+ migraines monthly my insurance doesn’t cover this, I have tried everything just need relief
Hi Theresa, most insurance companies are still determining whether they will cover it or not, so don’t write off your insurance company entirely. Even if they don’t cover it now, they likely could a year from now. Amgen has programs to help pay for the cost while insurance companies are in limbo. Here’s more information: http://www.thedailyheadache.com/2018/06/how-to-pay-for-aimovig-amgens-new-migraine-prevention-drug.html.
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.
Do you know if Arkansas medicaid patients will be covered for aimovig treatment?
Hi Debbie, you’ll need to contact them directly. Best of luck!
Thanks for all the info Kerrie!!!
I get daily migraines. I am 79 and have had a stroke. Is this a drug I can take?
Hi Kathleen, I really don’t know. You’ll need to check with your doctor.