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Does Blue Cross Blue Shield of Illinois Cover Aimovig

Learn about Aimovig coverage with Blue Cross Blue Shield of Illinois, potential denial reasons, costs without insurance, and FAQs for informed decisions.

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Coverage for Aimovig under Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Illinois generally covers Aimovig for individuals diagnosed with chronic migraine who meet specific criteria.

Patients typically need to have tried and failed other preventive migraine treatments before qualifying for Aimovig coverage.

Coverage may require prior authorization, meaning your healthcare provider must submit documentation to confirm that Aimovig is medically necessary.

It's essential to consult the specific terms of your policy as coverage rules can vary; some plans may have preferred drug lists affecting Aimovig's coverage.

Contact Blue Cross Blue Shield of Illinois directly or review your policy details for comprehensive coverage requirements and any potential exclusions.

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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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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 Blue Cross Blue Shield of Illinois

Check Your Insurance Plan Details

Log in to your Blue Cross Blue Shield of Illinois (BCBSIL) member account to review your current health insurance benefits.
Search for prescription drug coverage and check if Aimovig is listed or if it falls under your plan's formulary.
Contact BCBSIL customer service for additional clarification on your coverage.

Consult with Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your condition and obtain a prescription if deemed appropriate.
Ask for assistance in providing necessary medical documentation to support your need for Aimovig to BCBSIL.

Request a Prior Authorization

Many insurance plans require prior authorization for Aimovig. Coordinate with your healthcare provider to submit a prior authorization request to BCBSIL.
Ensure all required medical records and justification for the medication are included in the submission.
Follow up with your healthcare provider to ensure the prior authorization request is complete and submitted in a timely manner.

Verify Approval and Fulfillment

Once the prior authorization request is submitted, track its status through your BCBSIL member account or by calling customer service.
Upon approval, confirm with BCBSIL and your pharmacy on how to obtain your Aimovig prescription.
If approved, check for specific mail-order or retail pharmacy options provided by BCBSIL for cost-effective fulfillment.

Appealing a Denial

If your request is denied, don’t hesitate to appeal. Work with your healthcare provider to submit an appeal with any additional documentation that supports your need for Aimovig.
Review denial notices for specific instructions and adhere to any deadlines outlined by BCBSIL.
Contact customer service to fully understand the reasons for denial and gather advice on strengthening your case for appeal.

Explore Patient Assistance Programs

If you face challenges in coverage or costs, research patient assistance programs provided by the manufacturer or third-party organizations.
Discuss these options with your healthcare provider to see if you're eligible for additional financial assistance.

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Does Blue Cross Blue Shield of Illinois Cover Aimovig

Learn about Aimovig coverage with Blue Cross Blue Shield of Illinois, potential denial reasons, costs without insurance, and FAQs for informed decisions.

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Is Aimovig Covered by Blue Cross Blue Shield of Illinois

Coverage for Aimovig under Blue Cross Blue Shield of Illinois

Blue Cross Blue Shield of Illinois generally covers Aimovig for individuals diagnosed with chronic migraine who meet specific criteria.

Patients typically need to have tried and failed other preventive migraine treatments before qualifying for Aimovig coverage.

Coverage may require prior authorization, meaning your healthcare provider must submit documentation to confirm that Aimovig is medically necessary.

It's essential to consult the specific terms of your policy as coverage rules can vary; some plans may have preferred drug lists affecting Aimovig's coverage.

Contact Blue Cross Blue Shield of Illinois directly or review your policy details for comprehensive coverage requirements and any potential exclusions.

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Blue Cross Blue Shield of Illinois's Approved Criteria for Aimovig Coverage

Eligibility Criteria for Aimovig Coverage

Patient has a diagnosis of chronic migraine as defined by 15 or more headache days per month, lasting for more than 3 months, which are not attributed to medication overuse.

Patient is aged 18 years or older.

There is documented evidence that the patient has experienced an inadequate response or intolerance to at least two different classes of migraine prophylactic therapies (e.g., beta-blockers, anticonvulsants, or antidepressants).

Patient must be under the care of a healthcare provider specializing in the management of neurological conditions such as migraines, which includes neurologists, headache specialists, or similar professionals.

Continuation of Therapy

Continued coverage of Aimovig requires documentation showing a clinically meaningful reduction in the frequency and severity of migraine attacks compared to baseline, after an initial 3-month treatment period.

There must be an on-going clinical evaluation by the healthcare provider to assess the long-term treatment objectives and necessity of Aimovig for chronic migraine management.

Coverage Specifics

Coverage is generally limited to the FDA-approved dosing regimen for Aimovig, which currently allows for monthly doses of 70mg or 140mg administered via subcutaneous injection.

Prior authorization by Blue Cross Blue Shield of Illinois is required to ensure all criteria are met before the commencement or continuation of Aimovig therapy.

Coverage for Aimovig is typically included in the pharmacy benefits under the patient's health plan with Blue Cross Blue Shield of Illinois, subject to any deductible, copay, or co-insurance requirements outlined in the specific healthcare plan.

Why Blue Cross Blue Shield of Illinois Might Deny Aimovig Coverage

Reasons for Denial of Aimovig Coverage by Blue Cross Blue Shield of Illinois

**Off-label Use:** Aimovig may not be covered if it is being prescribed for a condition that is not indicated in its FDA-approved labeling.

**Lack of Prior Authorization:** Coverage could be denied if Aimovig is prescribed without obtaining prior authorization from Blue Cross Blue Shield of Illinois.

**Non-compliance with Step Therapy Requirements:** If the member has not tried and failed other medications as part of a step therapy process, Aimovig coverage could be denied.

**Failure to Meet Clinical Criteria:** Individuals may not receive coverage if they do not meet specified clinical criteria, such as having a certain frequency or severity of migraines as established by the insurer.

**Out-of-network Prescribers:** Claims might be denied if Aimovig is prescribed by a healthcare provider who is not within the Blue Cross Blue Shield of Illinois network.

**Formulary Restrictions:** Aimovig might not be covered if it is not included in the insurer's drug formulary, or if there is a preferred alternative medication listed.

**Renewal and Duration Limitations:** Continuation of coverage may be denied if the treatment duration exceeds defined limits, and prescription renewals might require additional documentation or reassessment.

**Policy Exclusions and Limitations:** General exclusions or limitations within the policy may specifically exclude Aimovig or similar treatments.

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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 Blue Cross Blue Shield of Illinois

Check Your Insurance Plan Details

Log in to your Blue Cross Blue Shield of Illinois (BCBSIL) member account to review your current health insurance benefits.
Search for prescription drug coverage and check if Aimovig is listed or if it falls under your plan's formulary.
Contact BCBSIL customer service for additional clarification on your coverage.

Consult with Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your condition and obtain a prescription if deemed appropriate.
Ask for assistance in providing necessary medical documentation to support your need for Aimovig to BCBSIL.

Request a Prior Authorization

Many insurance plans require prior authorization for Aimovig. Coordinate with your healthcare provider to submit a prior authorization request to BCBSIL.
Ensure all required medical records and justification for the medication are included in the submission.
Follow up with your healthcare provider to ensure the prior authorization request is complete and submitted in a timely manner.

Verify Approval and Fulfillment

Once the prior authorization request is submitted, track its status through your BCBSIL member account or by calling customer service.
Upon approval, confirm with BCBSIL and your pharmacy on how to obtain your Aimovig prescription.
If approved, check for specific mail-order or retail pharmacy options provided by BCBSIL for cost-effective fulfillment.

Appealing a Denial

If your request is denied, don’t hesitate to appeal. Work with your healthcare provider to submit an appeal with any additional documentation that supports your need for Aimovig.
Review denial notices for specific instructions and adhere to any deadlines outlined by BCBSIL.
Contact customer service to fully understand the reasons for denial and gather advice on strengthening your case for appeal.

Explore Patient Assistance Programs

If you face challenges in coverage or costs, research patient assistance programs provided by the manufacturer or third-party organizations.
Discuss these options with your healthcare provider to see if you're eligible for additional financial assistance.

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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 Blue Cross Blue Shield of Illinois Cover Aimovig

Learn about Aimovig coverage with Blue Cross Blue Shield of Illinois, potential denial reasons, costs without insurance, and FAQs for informed decisions.

Achieve Your Goals Faster with Curex