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Does Blue Cross Blue Shield of Michigan Cover Aimovig

Discover if Blue Cross Blue Shield of Michigan covers Aimovig, potential denial reasons, coverage strategies, Aimovig costs without insurance, and FAQs.

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Coverage for Aimovig

Blue Cross Blue Shield of Michigan may cover Aimovig for the treatment of migraine prevention under certain conditions. Approval often depends on medical necessity and the plan's specific coverage policies.

Patients typically must have a diagnosis related to chronic migraines, demonstrated by a sufficient frequency of migraine days per month.

Prior Authorization is usually required to determine eligibility and coverage, so it's crucial to have documentation from a healthcare provider substantiating the need for Aimovig.

Insurance plans may require that patients have tried and failed to respond to other preventive treatments, which should be documented as part of the approval process.

Check the specific terms of your policy or contact Blue Cross Blue Shield of Michigan directly for detailed information on coverage, co-pays, and any steps necessary to ensure Aimovig is a covered benefit.

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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 Michigan

Verify Eligibility for Aimovig Coverage

Contact Blue Cross Blue Shield of Michigan to confirm that Aimovig is included in your specific health insurance plan. Some plans may have restrictions or requirements for coverage.

Check the pharmaceutical coverage details in your plan’s documentation or online member portal to understand any prerequisites or restrictions.

Consultation with Healthcare Provider

Discuss Aimovig with your healthcare provider to determine if it's a suitable treatment option for your condition. They can provide medical justification if required by your insurer.

Your healthcare provider might need to provide a prescription along with documentation of your medical history and previous treatments tried.

Pre-Authorization Request

Work with your healthcare provider to submit a pre-authorization request to Blue Cross Blue Shield of Michigan. This often involves providing documentation supporting the medical necessity of Aimovig.

Ensure all required forms and medical documentation are correctly filled out and submitted in accordance with Blue Cross Blue Shield's guidelines.

Review of Pre-Authorization by Insurance

Blue Cross Blue Shield of Michigan will review the pre-authorization request. This may involve assessing medical records, previous treatments, and necessity for Aimovig.

Be prepared for a possible insurance review or request for additional information to support the case for Aimovig.

Follow Up and Appeals

If the initial pre-authorization request is denied, review the reasons provided by Blue Cross Blue Shield of Michigan. This could include missing documentation or insufficient evidence of necessity.

Work with your healthcare provider to address any issues and submit an appeal if necessary. Appeals often require additional documentation or a more detailed explanation of the need for Aimovig.

Explore Assistance Programs

If you encounter difficulties in obtaining coverage, consider reaching out to Aimovig manufacturer assistance programs which may offer support or cost reduction options.

Investigate state or local health programs that might assist with covering Aimovig if insurance options are exhausted.

Pharmacy Coordination

Once authorized, coordinate with your pharmacy to ensure Aimovig is in stock and that they process your Blue Cross Blue Shield plan correctly.

Monitor the pharmacy’s billing process to ensure coverage is applied correctly and any copays or out-of-pocket expenses are clarified.

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FAQs

Does Blue Cross Blue Shield of Michigan Cover Aimovig

Discover if Blue Cross Blue Shield of Michigan covers Aimovig, potential denial reasons, coverage strategies, Aimovig costs without insurance, and FAQs.

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Is Aimovig Covered by Blue Cross Blue Shield of Michigan

Coverage for Aimovig

Blue Cross Blue Shield of Michigan may cover Aimovig for the treatment of migraine prevention under certain conditions. Approval often depends on medical necessity and the plan's specific coverage policies.

Patients typically must have a diagnosis related to chronic migraines, demonstrated by a sufficient frequency of migraine days per month.

Prior Authorization is usually required to determine eligibility and coverage, so it's crucial to have documentation from a healthcare provider substantiating the need for Aimovig.

Insurance plans may require that patients have tried and failed to respond to other preventive treatments, which should be documented as part of the approval process.

Check the specific terms of your policy or contact Blue Cross Blue Shield of Michigan directly for detailed information on coverage, co-pays, and any steps necessary to ensure Aimovig is a covered benefit.

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

Criteria for Aimovig Coverage by Blue Cross Blue Shield of Michigan

**Diagnosis of Migraine:** The patient must have a confirmed diagnosis of episodic or chronic migraine as documented by a healthcare professional.

**Previous Treatment Requirements:** The patient should have tried and had insufficient response or intolerable side effects to at least two different classes of preventive migraine medications. Examples include beta blockers, anticonvulsants, antidepressants, or onabotulinumtoxinA (Botox) for chronic migraines.

**Medication Usage Compliance:** Documentation must show that the patient has been compliant with previous preventive migraine treatments.

**Prescribing Physician:** Aimovig must be prescribed by or in consultation with a neurologist or a headache specialist with expertise in the treatment of migraines.

**Age Requirement:** The patient must be 18 years of age or older to qualify for coverage for Aimovig.

**Drug-Specific Criteria:** The prescribing information and recommended dosage regimen as per the FDA approval must be adhered to when prescribing Aimovig.

**Benefit Management Criteria:** The medication must be covered under the patient's specific prescription drug benefit plan. Verification and pre-approval might be required by Blue Cross Blue Shield of Michigan before initiation of treatment.

Why Blue Cross Blue Shield of Michigan Might Deny Aimovig Coverage

Exclusions for Aimovig Coverage

Non-FDA Approved Uses: Aimovig is not covered for uses that have not been approved by the Food and Drug Administration (FDA).

Non-Migraine Conditions: Coverage is denied when Aimovig is prescribed for conditions other than migraine prevention.

Unapproved Dosage or Frequency: If prescribed quantities or frequency exceed FDA-approved dosage or established limitations without supporting medical necessity documentation, coverage may be denied.

Experimental or Investigational Use: Aimovig is not covered for any food, drug, device, treatment, or procedure considered experimental or investigational.

Lack of Prior Authorization: Claims may not be covered if prior authorization requirements were not met before filling the prescription.

Non-compliance with Step Therapy: Failure to try other medications or therapies deemed necessary by Blue Cross Blue Shield of Michigan before using Aimovig might result in non-coverage.

Non-compliance with Plan Restrictions: Use that does not align with specific plan restrictions, such as network pharmacy limitations, may result in denied claims.

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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 Michigan

Verify Eligibility for Aimovig Coverage

Contact Blue Cross Blue Shield of Michigan to confirm that Aimovig is included in your specific health insurance plan. Some plans may have restrictions or requirements for coverage.

Check the pharmaceutical coverage details in your plan’s documentation or online member portal to understand any prerequisites or restrictions.

Consultation with Healthcare Provider

Discuss Aimovig with your healthcare provider to determine if it's a suitable treatment option for your condition. They can provide medical justification if required by your insurer.

Your healthcare provider might need to provide a prescription along with documentation of your medical history and previous treatments tried.

Pre-Authorization Request

Work with your healthcare provider to submit a pre-authorization request to Blue Cross Blue Shield of Michigan. This often involves providing documentation supporting the medical necessity of Aimovig.

Ensure all required forms and medical documentation are correctly filled out and submitted in accordance with Blue Cross Blue Shield's guidelines.

Review of Pre-Authorization by Insurance

Blue Cross Blue Shield of Michigan will review the pre-authorization request. This may involve assessing medical records, previous treatments, and necessity for Aimovig.

Be prepared for a possible insurance review or request for additional information to support the case for Aimovig.

Follow Up and Appeals

If the initial pre-authorization request is denied, review the reasons provided by Blue Cross Blue Shield of Michigan. This could include missing documentation or insufficient evidence of necessity.

Work with your healthcare provider to address any issues and submit an appeal if necessary. Appeals often require additional documentation or a more detailed explanation of the need for Aimovig.

Explore Assistance Programs

If you encounter difficulties in obtaining coverage, consider reaching out to Aimovig manufacturer assistance programs which may offer support or cost reduction options.

Investigate state or local health programs that might assist with covering Aimovig if insurance options are exhausted.

Pharmacy Coordination

Once authorized, coordinate with your pharmacy to ensure Aimovig is in stock and that they process your Blue Cross Blue Shield plan correctly.

Monitor the pharmacy’s billing process to ensure coverage is applied correctly and any copays or out-of-pocket expenses are clarified.

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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 Michigan Cover Aimovig

Discover if Blue Cross Blue Shield of Michigan covers Aimovig, potential denial reasons, coverage strategies, Aimovig costs without insurance, and FAQs.

Achieve Your Goals Faster with Curex