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Does Affinity Health Plan Cover Aimovig

Explore Aimovig coverage under Affinity Health Plan, reasons for denial, costs without insurance, and get answers to common questions in this comprehensive guide.

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Does Affinity Health Plan Cover Aimovig?

Coverage often depends on individual plan details. Generally, Aimovig may be covered for patients suffering from chronic migraine conditions.

Eligibility usually requires prior authorization to confirm the necessity based on medical history and migraine frequency.

A doctor’s prescription and medical documentation supporting the use of Aimovig as a treatment option may be necessary.

Patients might need to try other therapies first, as there could be step therapy protocols in place.

Check with Affinity Health Plan’s member services for specific coverage details under your policy.

Ensure that the healthcare provider administering Aimovig is within the Affinity network to maximize benefits and minimize out-of-pocket costs.

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Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

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At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

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Immunotherapy made simple. We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Aimovig Coverage with Affinity Health Plan

Check Aimovig Eligibility

Contact your healthcare provider to determine if Aimovig is recommended for your condition and to verify that you meet the medical criteria.

Gather relevant medical documentation that confirms your need for Aimovig.

Review Affinity Health Plan Policies

Visit the official Affinity Health Plan website and log in to your member portal for personalized information.

Check the list of covered medications to see if Aimovig is included under your current plan.

Read through the prescription drug policies to understand any requirements or restrictions for specialty medications like Aimovig.

Consult with Affinity Health Plan Customer Service

Call Affinity Health Plan's customer service hotline using the number on your insurance card.

Inquire about the specific process for obtaining coverage for Aimovig, including any necessary prior authorizations or documentation.

Request a detailed explanation of any co-pays, out-of-pocket costs, and whether Aimovig is part of the formulary.

Get Prescription from Healthcare Provider

Schedule a visit with your healthcare provider to discuss the possibility of prescribing Aimovig.

Ensure your provider sends a detailed medical justification for your Aimovig prescription to Affinity Health Plan if required.

Complete Prior Authorization

Work with your healthcare provider to complete any prior authorization forms required by Affinity Health Plan.

Submit all necessary documentation, including medical justifications or previous treatment attempts, along with the authorization form.

Follow up with Affinity Health Plan to confirm receipt and processing of your prior authorization request.

Review Approval and Coverage Details

Wait for a response from Affinity Health Plan regarding your prior authorization. This can take several days to weeks.

Once approved, review the coverage details such as any limitations, the length of coverage, and your share of costs.

Fill Your Prescription

Choose a pharmacy that works with Affinity Health Plan to fill your Aimovig prescription.

Provide your insurance details and any approval documents from Affinity Health Plan to the pharmacy.

Appeal if Necessary

If your request for Aimovig coverage is denied, consult with Affinity Health Plan to understand the reasons for denial.

Collect additional information or documentation, if needed, and follow the appeals process as outlined by Affinity Health Plan.

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FAQs

Does Affinity Health Plan Cover Aimovig

Explore Aimovig coverage under Affinity Health Plan, reasons for denial, costs without insurance, and get answers to common questions in this comprehensive guide.

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Is Aimovig Covered by Affinity Health Plan

Does Affinity Health Plan Cover Aimovig?

Coverage often depends on individual plan details. Generally, Aimovig may be covered for patients suffering from chronic migraine conditions.

Eligibility usually requires prior authorization to confirm the necessity based on medical history and migraine frequency.

A doctor’s prescription and medical documentation supporting the use of Aimovig as a treatment option may be necessary.

Patients might need to try other therapies first, as there could be step therapy protocols in place.

Check with Affinity Health Plan’s member services for specific coverage details under your policy.

Ensure that the healthcare provider administering Aimovig is within the Affinity network to maximize benefits and minimize out-of-pocket costs.

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Affinity Health Plan's Approved Criteria for Aimovig Coverage

Eligibility Criteria for Aimovig Coverage

Patient must be diagnosed with chronic or episodic migraines as confirmed by a healthcare provider.

Documentation of the frequency and severity of migraine episodes must be provided as part of the application process.

Patient should have a history of treatment with at least two different types of preventive migraine medications that were either not effective or resulted in intolerable side effects.

Evidence of ongoing migraine management, which could include lifestyle modifications and non-pharmacological interventions such as cognitive behavioral therapy, is required.

Prescription Guidelines

Aimovig must be prescribed by a neurologist or a healthcare provider specializing in the treatment of migraines.

The prescription must indicate the recommended dosage aligned with FDA-approved guidelines.

The treatment plan should include a follow-up evaluation within 3 months to assess the effectiveness and any side effects of Aimovig.

Coverage Duration and Renewal

Initial approval for coverage will extend for a period of 3 months, contingent on the submission of an ongoing treatment evaluation.

For coverage renewal, updated clinical notes from the healthcare provider must demonstrate a reduction in migraine frequency or intensity and overall improvement in patient quality of life.

Continued coverage will be contingent on adherence to the prescribed Aimovig regimen and regular follow-up consultations.

Patient Support and Resources

Patients are encouraged to participate in patient education programs that provide resources on Aimovig usage and migraine management strategies.

Access to a dedicated support line is available to assist with questions related to Aimovig treatment and insurance coverage inquiries.

Patients may qualify for financial assistance programs if they meet certain income and insurance criteria, as determined by Affinity Health Plan.

Why Affinity Health Plan Might Deny Aimovig Coverage

Situations Where Aimovig is Not Covered by Affinity Health Plan

Aimovig may not be covered if the patient has not exhausted all alternative therapies that are more cost-effective and clinically appropriate for migraine prevention.

Coverage might be denied if proper documentation of chronic migraine diagnosis according to standard medical guidelines is missing.

If the prescribed Aimovig dosage does not align with FDA-approved dosing guidelines or the dosage exceeds what is deemed medically necessary, coverage may be refused.

Aimovig is unlikely to be covered if there is a lack of documentation showing improvement with the medication, such as a reduction in migraine days or intensity after starting treatment.

Coverage for Aimovig could be withheld if there are affordability concerns and there are no attempts to utilize any available manufacturer assistance programs first.

If the prescription is not from a licensed healthcare provider specializing in headache and migraine management, Affinity Health Plan may deny coverage.

Coverage may be denied if there are existing medical conditions that contraindicate the use of Aimovig according to healthcare guidelines.

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How Much Does Aimovig Cost without Insurance?

Understanding the Cost of Aimovig Without Insurance

Aimovig, a medication for preventing migraines, can be quite expensive without insurance coverage.
The cost of Aimovig typically ranges from $575 to $725 per month for a single dose, depending on the pharmacy and geographic location.
This price reflects the retail cost for the 70 mg dosage, which is commonly used in migraine prevention treatment.
The 140 mg dosage generally costs about the same per unit; however, as a higher dose, it could be slightly more expensive overall, since some patients might be prescribed two doses of 70 mg.

Additional Considerations

Prices can vary significantly due to factors such as pharmacy pricing policies, location, and availability.
Discount programs and pharmaceutical aid may be available for eligible patients, which can help reduce the out-of-pocket cost.
It's advisable for patients to shop around, as different pharmacies may offer various pricing or additional discounts.
Patients should also consider discussing with their healthcare provider about any available generic alternatives or other cost-effective treatment options.

Clinical Support

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

Jill Hamburg, PA - C

Immunotherapy made simple. We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Kayla Mardaga, NP

How to Get Aimovig Coverage with Affinity Health Plan

Check Aimovig Eligibility

Contact your healthcare provider to determine if Aimovig is recommended for your condition and to verify that you meet the medical criteria.

Gather relevant medical documentation that confirms your need for Aimovig.

Review Affinity Health Plan Policies

Visit the official Affinity Health Plan website and log in to your member portal for personalized information.

Check the list of covered medications to see if Aimovig is included under your current plan.

Read through the prescription drug policies to understand any requirements or restrictions for specialty medications like Aimovig.

Consult with Affinity Health Plan Customer Service

Call Affinity Health Plan's customer service hotline using the number on your insurance card.

Inquire about the specific process for obtaining coverage for Aimovig, including any necessary prior authorizations or documentation.

Request a detailed explanation of any co-pays, out-of-pocket costs, and whether Aimovig is part of the formulary.

Get Prescription from Healthcare Provider

Schedule a visit with your healthcare provider to discuss the possibility of prescribing Aimovig.

Ensure your provider sends a detailed medical justification for your Aimovig prescription to Affinity Health Plan if required.

Complete Prior Authorization

Work with your healthcare provider to complete any prior authorization forms required by Affinity Health Plan.

Submit all necessary documentation, including medical justifications or previous treatment attempts, along with the authorization form.

Follow up with Affinity Health Plan to confirm receipt and processing of your prior authorization request.

Review Approval and Coverage Details

Wait for a response from Affinity Health Plan regarding your prior authorization. This can take several days to weeks.

Once approved, review the coverage details such as any limitations, the length of coverage, and your share of costs.

Fill Your Prescription

Choose a pharmacy that works with Affinity Health Plan to fill your Aimovig prescription.

Provide your insurance details and any approval documents from Affinity Health Plan to the pharmacy.

Appeal if Necessary

If your request for Aimovig coverage is denied, consult with Affinity Health Plan to understand the reasons for denial.

Collect additional information or documentation, if needed, and follow the appeals process as outlined by Affinity Health Plan.

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Aimovig FAQ

1. What are the common side effects of Aimovig?

Common Side Effects of Aimovig

**Injection site reactions**: You may experience pain, redness, or swelling where the injection was administered.

**Constipation**: This is a frequently reported side effect, which may vary in severity.

**Muscle spasms**: Some patients may encounter muscle spasms post-administration.

**Fatigue**: Feeling unusually tired or exhausted can commonly occur.

**Nausea**: A feeling of queasiness may be experienced, often mild but potentially bothersome.

Note

Consult with a healthcare provider if side effects persist or worsen.

Serious side effects are rare but should be addressed immediately with professional advice.

2. How does Aimovig work to prevent migraines?

What is Aimovig?

Aimovig is a monoclonal antibody used for preventing migraines by targeting the CGRP pathway.

How Aimovig Works

Aimovig binds to the calcitonin gene-related peptide (CGRP) receptor, inhibiting its activity.
By blocking CGRP, Aimovig reduces vasodilation and inflammation, commonly linked to migraines.
This prevention mechanism helps decrease the frequency and intensity of migraine attacks.

Usage and Administration

Aimovig is administered through a monthly subcutaneous injection, making it convenient for most patients.
It's crucial to follow prescribed dosing and consult healthcare providers if any side effects occur.

3. How long does it take for Aimovig to start working?

How Aimovig Works

Aimovig is a monoclonal antibody that targets and inhibits the CGRP receptor, helping to prevent migraine onset.

It is specifically designed to reduce the frequency of migraine days by interfering with a key pathway in migraine pathophysiology.

Onset of Effects

Patients may begin to notice a reduction in migraine frequency as early as one week after the first injection.

Clinical trials indicate that significant reduction in migraine days is typically observed within 3 to 4 weeks of starting Aimovig.

Full therapeutic benefits can develop over subsequent months, and individual response times may vary.

Recommendations

Maintain a migraine diary to monitor changes and discuss them with your healthcare provider.

Continue regular check-ins with your doctor to assess effectiveness and make any necessary adjustments to treatment.

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Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide. Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. We don’t prescribe Ozempic®* or Wegovy®.* We may prescribe treatments containing compounded semaglutide or tirzepatide. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Does Affinity Health Plan Cover Aimovig

Explore Aimovig coverage under Affinity Health Plan, reasons for denial, costs without insurance, and get answers to common questions in this comprehensive guide.

Achieve Your Goals Faster with Curex