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Does Blue Shield of California Cover Aimovig

Explore Aimovig coverage by Blue Shield of California, reasons for denial, coverage tips, costs without insurance, and FAQs in this comprehensive guide.

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Coverage Overview

Blue Shield of California may cover Aimovig for eligible members under specific conditions related to migraine prevention.

Coverage usually requires prior authorization to ensure the medication is medically necessary.

Eligibility Criteria

Members typically need to have a documented medical history of chronic migraines that have been poorly managed with alternative treatments.

Members must follow any required step therapy protocols, possibly trying alternative medications before receiving approval for Aimovig.

Basic Rules

Prescriptions must be written by a healthcare provider specialized in neurology or headache treatment.

Regular review and renewal may be necessary to ensure continued coverage based on treatment outcomes.

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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 Shield of California

Verify Your Plan Details

Log into your Blue Shield of California member portal to review your specific plan details.

Check the prescription drug coverage section to ensure Aimovig is listed. This information can usually be found in your plan's formulary document.

Consult with Your Healthcare Provider

Discuss with your doctor the necessity of Aimovig for your treatment plan. Your healthcare provider can help provide medical justification, which may be needed for insurance coverage.

Request a formal prescription from your healthcare provider, including all relevant medical diagnoses that justify the use of Aimovig.

Contact Blue Shield of California

Call the customer service number listed on your insurance card to inquire about Aimovig coverage specifically.

Ask about any prior authorization requirements or specific documentation needed to process your Aimovig prescription.

Submit a Prior Authorization Request

If required, have your healthcare provider submit a prior authorization request on your behalf. This includes medical records, a prescription, and any additional documentation requested by Blue Shield of California.

Monitor your communication with your healthcare provider to ensure they submit the necessary documents promptly.

Follow Up on Your Request

Track the status of your prior authorization request through your Blue Shield of California member account or by contacting customer service.

If your request is delayed or denied, ask for detailed reasons and clarification on how the issue can be resolved.

Appeal if Necessary

If your initial request is denied, file an appeal with Blue Shield of California. Gather additional supporting documentation from your healthcare provider that emphasizes the necessity of Aimovig for your condition.

Adhere to the appeal timelines and procedures outlined by Blue Shield of California to ensure your appeal is considered.

Visit an In-Network Pharmacy

Once approved, fill your Aimovig prescription at a Blue Shield of California in-network pharmacy to utilize your insurance benefits fully.

Present any documentation, such as your approval notice, if required by the pharmacy for processing your insurance claim.

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Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

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FAQs

Does Blue Shield of California Cover Aimovig

Explore Aimovig coverage by Blue Shield of California, reasons for denial, coverage tips, costs without insurance, and FAQs in this comprehensive guide.

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Is Aimovig Covered by Blue Shield of California

Coverage Overview

Blue Shield of California may cover Aimovig for eligible members under specific conditions related to migraine prevention.

Coverage usually requires prior authorization to ensure the medication is medically necessary.

Eligibility Criteria

Members typically need to have a documented medical history of chronic migraines that have been poorly managed with alternative treatments.

Members must follow any required step therapy protocols, possibly trying alternative medications before receiving approval for Aimovig.

Basic Rules

Prescriptions must be written by a healthcare provider specialized in neurology or headache treatment.

Regular review and renewal may be necessary to ensure continued coverage based on treatment outcomes.

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Blue Shield of California's Approved Criteria for Aimovig Coverage

Criteria for Aimovig Coverage

The patient must have a diagnosis of migraine, including episodic migraine or chronic migraine, confirmed by a healthcare professional.

Aimovig is appropriate for patients aged 18 years or older.

The patient has experienced at least four migraine days per month.

There must be documented evidence that the patient has tried and had an inadequate response, intolerance, or contraindication to at least two other preventive therapies.

Aimovig should be prescribed by, or in consultation with, a neurologist or a headache specialist.

For continued approval, there must be documented evidence of a clinically significant response as evidenced by a reduction in the number of headache days per month or a significant decrease in headache severity or duration.

Approval is typically given initially for a duration of 3 to 6 months, with re-evaluation required for continued coverage.

The patient should not be using Aimovig in combination with other CGRP inhibitors for migraine prevention without prior authorization.

Why Blue Shield of California Might Deny Aimovig Coverage

Criteria for Denial of Aimovig Coverage

Aimovig is prescribed for non-FDA approved uses or off-label indications that have not been recognized by Blue Shield of California's policy guidelines.

The patient does not meet the established criteria for chronic migraine diagnosis, such as experiencing fewer than 4 migraine days per month.

Use of Aimovig is for conditions or symptoms where alternative treatments have not been attempted, despite being recommended in the Blue Shield of California's treatment protocol.

Prescriptions that exceed the safety dosage limits or lack documentation of the necessary treatment plan duration as per Blue Shield guidelines.

Requests for Aimovig from non-participating providers or pharmacies that are not within Blue Shield's approved network of healthcare providers.

The prescribed Aimovig does not comply with the step therapy protocol, which may require the trial and failure of other preferred medications first.

Situations where coverage is sought without sufficient clinical evidence or history documentation that supports the necessity of Aimovig.

Non-compliance with pre-authorization requirements such as necessary medical assessments or diagnostic tests that are prerequisites for approval.

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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 Shield of California

Verify Your Plan Details

Log into your Blue Shield of California member portal to review your specific plan details.

Check the prescription drug coverage section to ensure Aimovig is listed. This information can usually be found in your plan's formulary document.

Consult with Your Healthcare Provider

Discuss with your doctor the necessity of Aimovig for your treatment plan. Your healthcare provider can help provide medical justification, which may be needed for insurance coverage.

Request a formal prescription from your healthcare provider, including all relevant medical diagnoses that justify the use of Aimovig.

Contact Blue Shield of California

Call the customer service number listed on your insurance card to inquire about Aimovig coverage specifically.

Ask about any prior authorization requirements or specific documentation needed to process your Aimovig prescription.

Submit a Prior Authorization Request

If required, have your healthcare provider submit a prior authorization request on your behalf. This includes medical records, a prescription, and any additional documentation requested by Blue Shield of California.

Monitor your communication with your healthcare provider to ensure they submit the necessary documents promptly.

Follow Up on Your Request

Track the status of your prior authorization request through your Blue Shield of California member account or by contacting customer service.

If your request is delayed or denied, ask for detailed reasons and clarification on how the issue can be resolved.

Appeal if Necessary

If your initial request is denied, file an appeal with Blue Shield of California. Gather additional supporting documentation from your healthcare provider that emphasizes the necessity of Aimovig for your condition.

Adhere to the appeal timelines and procedures outlined by Blue Shield of California to ensure your appeal is considered.

Visit an In-Network Pharmacy

Once approved, fill your Aimovig prescription at a Blue Shield of California in-network pharmacy to utilize your insurance benefits fully.

Present any documentation, such as your approval notice, if required by the pharmacy for processing your insurance claim.

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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 Shield of California Cover Aimovig

Explore Aimovig coverage by Blue Shield of California, reasons for denial, coverage tips, costs without insurance, and FAQs in this comprehensive guide.

Achieve Your Goals Faster with Curex