Does EmblemHealth Cover Aimovig

Discover if Aimovig is covered by EmblemHealth. Learn why coverage may be denied, how to secure it, costs without insurance, and find answers to FAQs.
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“Curex is changing the landscape of allergies in 2024”
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EmblemHealth Coverage for Aimovig

 

  • Aimovig (erenumab) is typically covered under EmblemHealth, subject to specific medical necessity criteria.
  •  

  • Coverage generally requires a diagnosis of episodic or chronic migraine.
  •  

  • Patients may need to show insufficient response to at least two other preventive treatments.
  •  

  • The prescribing healthcare provider often must provide documentation supporting the need for Aimovig as a treatment option.
  •  

  • Pre-authorization is commonly required to ensure coverage, so it's essential to notify EmblemHealth before beginning treatment.
  •  

  • Patients should consult with their healthcare provider and EmblemHealth to understand specific policy details, including potential copays and quantity limits.

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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

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.

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

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 EmblemHealth

 

Verify Eligibility

 

  • Contact EmblemHealth Customer Service using the number on the back of your insurance card to confirm your eligibility for prescription drug coverage.
  •  

  • Ask specifically about coverage for Aimovig, including any requirements or conditions that must be met to get it approved.
  •  

  • Request detailed information on any prior authorization forms or documentation you may need to provide.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Aimovig in your treatment plan.
  •  

  • Request that your healthcare provider prepares medical documentation and prescription details to support your case for coverage.
  •  

  • Ensure your healthcare provider is aware of EmblemHealth’s specific procedures for submitting prior authorization requests for Aimovig.

 

Get Prior Authorization

 

  • Have your healthcare provider submit a prior authorization request to EmblemHealth. This might include medical records, treatment history, and justification for prescribing Aimovig.
  •  

  • Ensure the prior authorization request clearly outlines the necessity of the medication and how it fits into your overall treatment plan.
  •  

  • Follow up with both your healthcare provider and EmblemHealth to check the status of the prior authorization and be ready to provide any additional documentation if requested.

 

Review Policy and Benefits

 

  • Review your EmblemHealth policy documents or member portal to understand your prescription benefits.
  •  

  • Look into any co-payments, deductibles, or out-of-pocket costs that may apply to Aimovig once it’s approved.
  •  

  • If you have a high deductible or co-pay, inquire about any available financial assistance or savings programs from Aimovig's manufacturer.

 

Appeal a Denial If Necessary

 

  • If your coverage request for Aimovig is denied, contact EmblemHealth to understand the reason for denial.
  •  

  • Work with your healthcare provider to gather additional support or documentation to strengthen your case and appeal the decision.
  •  

  • Submit an appeal to EmblemHealth substantiating why Aimovig is necessary for your treatment and wait for the resolution.

 

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Does EmblemHealth Cover Aimovig

Discover if Aimovig is covered by EmblemHealth. Learn why coverage may be denied, how to secure it, costs without insurance, and find answers to FAQs.
Curex allergy drops unboxing

Is Aimovig Covered by EmblemHealth

 

EmblemHealth Coverage for Aimovig

 

  • Aimovig (erenumab) is typically covered under EmblemHealth, subject to specific medical necessity criteria.
  •  

  • Coverage generally requires a diagnosis of episodic or chronic migraine.
  •  

  • Patients may need to show insufficient response to at least two other preventive treatments.
  •  

  • The prescribing healthcare provider often must provide documentation supporting the need for Aimovig as a treatment option.
  •  

  • Pre-authorization is commonly required to ensure coverage, so it's essential to notify EmblemHealth before beginning treatment.
  •  

  • Patients should consult with their healthcare provider and EmblemHealth to understand specific policy details, including potential copays and quantity limits.

A weight management program tailored to you

Start with Curex

EmblemHealth's Approved Criteria for Aimovig Coverage

 

Eligibility Criteria for Aimovig Coverage

 

  • Must have a diagnosis of migraine headache as confirmed by a healthcare provider.
  •  

  • Must demonstrate a history of four or more migraine days per month.
  •  

  • Must have tried and failed at least two different classes of preventive migraine medications, unless there is a documented clinical reason for not trying them.
  •  

  • Medical documentation should support the diagnosis and failed preventive treatment trials.

 

Provider Involvement and Prescription

 

  • A licensed healthcare provider must prescribe Aimovig.
  •  

  • The prescribing healthcare provider should have experience in managing migraines.

 

Use Within Recommended Guidelines

 

  • Aimovig must be used according to FDA-approved labeling, including dosing recommendations, unless otherwise specified by a healthcare provider with supporting documentation.

 

Continuation of Therapy Requirements

 

  • Continuation of therapy will require documentation showing a decrease in the number of migraine days per month, demonstrating treatment efficacy.
  •  

  • The patient must not experience unacceptable toxicity from the medication.

 

Why EmblemHealth Might Deny Aimovig Coverage

 

Situations Where EmblemHealth Might Deny Aimovig Coverage

 

  • Aimovig is requested for any condition other than migraine prevention, as its FDA-approval is specific to migraine prevention only.
  •  

  • Aimovig is prescribed for a patient who does not meet specific migraine frequency criteria, such as experiencing fewer chronic migraines than required by policy guidelines.
  •  

  • The patient has not demonstrated a trial and failure of preventative medications that are typically required before Aimovig can be considered.
  •  

  • There is evidence of non-compliance with previously recommended migraine preventative therapies, which can include medication adherence or lifestyle modifications.
  •  

  • The prescribing healthcare provider does not supply sufficient documentation to support the medical necessity of prescribing Aimovig, as per EmblemHealth's policy documentation requirements.
  •  

  • Aimovig is prescribed in doses, frequency, or conditions outside the FDA-approved guidelines without clear and adequate justification of necessity from the prescribing physician.
  •  

Together with our partners we have changed the lives of over 300,000 patients.

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.

 

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

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.

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

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 EmblemHealth

 

Verify Eligibility

 

  • Contact EmblemHealth Customer Service using the number on the back of your insurance card to confirm your eligibility for prescription drug coverage.
  •  

  • Ask specifically about coverage for Aimovig, including any requirements or conditions that must be met to get it approved.
  •  

  • Request detailed information on any prior authorization forms or documentation you may need to provide.

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Aimovig in your treatment plan.
  •  

  • Request that your healthcare provider prepares medical documentation and prescription details to support your case for coverage.
  •  

  • Ensure your healthcare provider is aware of EmblemHealth’s specific procedures for submitting prior authorization requests for Aimovig.

 

Get Prior Authorization

 

  • Have your healthcare provider submit a prior authorization request to EmblemHealth. This might include medical records, treatment history, and justification for prescribing Aimovig.
  •  

  • Ensure the prior authorization request clearly outlines the necessity of the medication and how it fits into your overall treatment plan.
  •  

  • Follow up with both your healthcare provider and EmblemHealth to check the status of the prior authorization and be ready to provide any additional documentation if requested.

 

Review Policy and Benefits

 

  • Review your EmblemHealth policy documents or member portal to understand your prescription benefits.
  •  

  • Look into any co-payments, deductibles, or out-of-pocket costs that may apply to Aimovig once it’s approved.
  •  

  • If you have a high deductible or co-pay, inquire about any available financial assistance or savings programs from Aimovig's manufacturer.

 

Appeal a Denial If Necessary

 

  • If your coverage request for Aimovig is denied, contact EmblemHealth to understand the reason for denial.
  •  

  • Work with your healthcare provider to gather additional support or documentation to strengthen your case and appeal the decision.
  •  

  • Submit an appeal to EmblemHealth substantiating why Aimovig is necessary for your treatment and wait for the resolution.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

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.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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 EmblemHealth Cover Aimovig

Discover if Aimovig is covered by EmblemHealth. Learn why coverage may be denied, how to secure it, costs without insurance, and find answers to FAQs.
Curex allergy drops unboxing

Does EmblemHealth Cover Aimovig

 

EmblemHealth Coverage for Aimovig

 

  • Aimovig (erenumab) is typically covered under EmblemHealth, subject to specific medical necessity criteria.
  •  

  • Coverage generally requires a diagnosis of episodic or chronic migraine.
  •  

  • Patients may need to show insufficient response to at least two other preventive treatments.
  •  

  • The prescribing healthcare provider often must provide documentation supporting the need for Aimovig as a treatment option.
  •  

  • Pre-authorization is commonly required to ensure coverage, so it's essential to notify EmblemHealth before beginning treatment.
  •  

  • Patients should consult with their healthcare provider and EmblemHealth to understand specific policy details, including potential copays and quantity limits.

A weight management program tailored to you

Start with Curex

Why EmblemHealth Might Deny Aimovig Coverage

 

Eligibility Criteria for Aimovig Coverage

 

  • Must have a diagnosis of migraine headache as confirmed by a healthcare provider.
  •  

  • Must demonstrate a history of four or more migraine days per month.
  •  

  • Must have tried and failed at least two different classes of preventive migraine medications, unless there is a documented clinical reason for not trying them.
  •  

  • Medical documentation should support the diagnosis and failed preventive treatment trials.

 

Provider Involvement and Prescription

 

  • A licensed healthcare provider must prescribe Aimovig.
  •  

  • The prescribing healthcare provider should have experience in managing migraines.

 

Use Within Recommended Guidelines

 

  • Aimovig must be used according to FDA-approved labeling, including dosing recommendations, unless otherwise specified by a healthcare provider with supporting documentation.

 

Continuation of Therapy Requirements

 

  • Continuation of therapy will require documentation showing a decrease in the number of migraine days per month, demonstrating treatment efficacy.
  •  

  • The patient must not experience unacceptable toxicity from the medication.

 

Together with our partners we have changed the lives of over 300,000 patients.

Aimovig FAQ

 

Situations Where EmblemHealth Might Deny Aimovig Coverage

 

  • Aimovig is requested for any condition other than migraine prevention, as its FDA-approval is specific to migraine prevention only.
  •  

  • Aimovig is prescribed for a patient who does not meet specific migraine frequency criteria, such as experiencing fewer chronic migraines than required by policy guidelines.
  •  

  • The patient has not demonstrated a trial and failure of preventative medications that are typically required before Aimovig can be considered.
  •  

  • There is evidence of non-compliance with previously recommended migraine preventative therapies, which can include medication adherence or lifestyle modifications.
  •  

  • The prescribing healthcare provider does not supply sufficient documentation to support the medical necessity of prescribing Aimovig, as per EmblemHealth's policy documentation requirements.
  •  

  • Aimovig is prescribed in doses, frequency, or conditions outside the FDA-approved guidelines without clear and adequate justification of necessity from the prescribing physician.
  •  

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

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.

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

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 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.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

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.