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Does Presbyterian Healthcare Services Cover Aimovig

Explore Aimovig coverage by Presbyterian Healthcare Services, denial reasons, ways to secure coverage, Aimovig costs without insurance, and an informative FAQ.

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Coverage for Aimovig by Presbyterian Healthcare Services

Presbyterian Healthcare Services may cover Aimovig, but it typically requires prior authorization. Coverage is often reserved for patients diagnosed with chronic migraines.

Patients must have tried and failed traditional preventive medications before Aimovig is approved. Documentation of these trials is usually necessary.

Criteria often include continued membership and adherence to the plan guidelines. Coverage may vary depending on the specific health plan.

It's essential for patients to consult with their healthcare provider and verify coverage details directly with Presbyterian Healthcare Services to ensure Aimovig is covered under their individual plan.

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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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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 Presbyterian Healthcare Services

Contact Presbyterian Healthcare Services

Begin by reaching out to your Presbyterian Healthcare Services (PHS) representative. Use the contact information provided on your insurance card or visit their official website for customer service details.
Ask specifically about prescription drug coverage for Aimovig to ensure you are directed to the appropriate department or personnel.

Verify Coverage and Formulary Status

Inquire about whether Aimovig is included in your plan’s formulary. This determines if the medication is covered and under what conditions.
Request detailed information about the tier placement of Aimovig within the formulary, as this will impact your co-payment or out-of-pocket costs.

Consult with Healthcare Provider

Talk to your healthcare provider to confirm that Aimovig is the correct medication for your condition and discuss the necessity and benefits of this specific treatment.
Your provider can assist in documenting medical necessity, which is a critical factor in gaining coverage approval from Presbyterian Healthcare Services.

Submit Prior Authorization, if Necessary

If Aimovig requires prior authorization, collaborate with your healthcare provider to complete any forms or gather required documentation demonstrating the medical necessity of Aimovig.
Ensure that this documentation is submitted to Presbyterian Healthcare Services in accordance with their guidelines to avoid delays in coverage.

Review Costs and Co-Pay Assistance Programs

Determine your specific co-pays, deductibles, or any other costs associated with Aimovig under your Presbyterian Healthcare Services plan.
Research available co-pay assistance programs. Some pharmaceutical companies and external organizations offer financial assistance to help manage medication costs.

Follow Up with Presbyterian Healthcare Services

Regularly follow up with Presbyterian Healthcare Services after submitting your documentation or request for prior authorization to check on the status of your Aimovig coverage.
Document all correspondence for your records, including any reference numbers or contact names, should further information be required later.

Appeal a Denied Claim

If your initial request for coverage is denied, review the denial reasons provided and discuss them with your healthcare provider to address and rectify the concerns.
Submit an appeal with additional documentation or supporting information as suggested by your healthcare provider to strengthen your case for coverage.

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FAQs

Does Presbyterian Healthcare Services Cover Aimovig

Explore Aimovig coverage by Presbyterian Healthcare Services, denial reasons, ways to secure coverage, Aimovig costs without insurance, and an informative FAQ.

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Is Aimovig Covered by Presbyterian Healthcare Services

Coverage for Aimovig by Presbyterian Healthcare Services

Presbyterian Healthcare Services may cover Aimovig, but it typically requires prior authorization. Coverage is often reserved for patients diagnosed with chronic migraines.

Patients must have tried and failed traditional preventive medications before Aimovig is approved. Documentation of these trials is usually necessary.

Criteria often include continued membership and adherence to the plan guidelines. Coverage may vary depending on the specific health plan.

It's essential for patients to consult with their healthcare provider and verify coverage details directly with Presbyterian Healthcare Services to ensure Aimovig is covered under their individual plan.

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Presbyterian Healthcare Services's Approved Criteria for Aimovig Coverage

Approved Criteria for Aimovig Coverage by Presbyterian Healthcare Services

Diagnosis of Chronic Migraine: Member must have been diagnosed with chronic migraine, defined as having headache on 15 or more days per month with at least 8 days of migraine for more than 3 months.

Previous Treatment Failure: Member must have tried and failed or had an intolerance to at least two different prophylactic medications, such as beta-blockers, antiepileptic drugs, or tricyclic antidepressants, unless contraindicated.

Documented Frequency: Medical documentation should indicate the frequency and severity of migraines as well as the associated functional impairment in daily activities.

Age Requirement: Member must be 18 years of age or older.

Specialist Consultation: Evaluation and recommendation for the use of Aimovig must be provided by a neurologist or headache specialist.

Dosage Limitation: Coverage is for the FDA-approved dosage and quantity limits to ensure appropriate utilization of Aimovig.

Continued Therapy Assessment: For ongoing coverage, regular follow-up assessment with the prescribing provider to determine the effectiveness of Aimovig in reducing migraine frequency and/or severity is required.

Why Presbyterian Healthcare Services Might Deny Aimovig Coverage

Criteria for Denial of Aimovig Coverage by Presbyterian Healthcare Services

Aimovig is requested for any off-label uses that are not approved by the Food and Drug Administration (FDA), even if such uses are supported by medical literature or practice guidelines.

The patient does not meet the established clinical criteria for migraine prevention, such as the documented frequency and severity of migraine attacks as determined by Presbyterian Healthcare Services' medical policy.

Adequate therapeutic trial and failure, or documented contraindications, are not demonstrated for at least two different classes of preventive migraine medications before seeking Aimovig approval.

Requests for Aimovig exceed the quantity limits defined by the health plan, or the prescribed dosage is higher than the maximum FDA-approved dose, without sufficient clinical rationale for such usage.

Aimovig is utilized in combination with other calcitonin gene-related peptide (CGRP) inhibitors or other similar migraine prevention therapies, unless specifically authorized under the health plan's policy.

The patient’s health insurance plan through Presbyterian Healthcare Services has specific exclusions for Aimovig, which can include certain plan types or account-based plans.

The policy does not cover federal or state programs such as Medicaid or Medicare if those plans have separate coverage guidelines that exclude Aimovig.

Non-compliance with prior authorization requirements or failure to provide necessary documentation supporting the medical necessity of Aimovig usage within the set timeframe.

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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 Presbyterian Healthcare Services

Contact Presbyterian Healthcare Services

Begin by reaching out to your Presbyterian Healthcare Services (PHS) representative. Use the contact information provided on your insurance card or visit their official website for customer service details.
Ask specifically about prescription drug coverage for Aimovig to ensure you are directed to the appropriate department or personnel.

Verify Coverage and Formulary Status

Inquire about whether Aimovig is included in your plan’s formulary. This determines if the medication is covered and under what conditions.
Request detailed information about the tier placement of Aimovig within the formulary, as this will impact your co-payment or out-of-pocket costs.

Consult with Healthcare Provider

Talk to your healthcare provider to confirm that Aimovig is the correct medication for your condition and discuss the necessity and benefits of this specific treatment.
Your provider can assist in documenting medical necessity, which is a critical factor in gaining coverage approval from Presbyterian Healthcare Services.

Submit Prior Authorization, if Necessary

If Aimovig requires prior authorization, collaborate with your healthcare provider to complete any forms or gather required documentation demonstrating the medical necessity of Aimovig.
Ensure that this documentation is submitted to Presbyterian Healthcare Services in accordance with their guidelines to avoid delays in coverage.

Review Costs and Co-Pay Assistance Programs

Determine your specific co-pays, deductibles, or any other costs associated with Aimovig under your Presbyterian Healthcare Services plan.
Research available co-pay assistance programs. Some pharmaceutical companies and external organizations offer financial assistance to help manage medication costs.

Follow Up with Presbyterian Healthcare Services

Regularly follow up with Presbyterian Healthcare Services after submitting your documentation or request for prior authorization to check on the status of your Aimovig coverage.
Document all correspondence for your records, including any reference numbers or contact names, should further information be required later.

Appeal a Denied Claim

If your initial request for coverage is denied, review the denial reasons provided and discuss them with your healthcare provider to address and rectify the concerns.
Submit an appeal with additional documentation or supporting information as suggested by your healthcare provider to strengthen your case for coverage.

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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 Presbyterian Healthcare Services Cover Aimovig

Explore Aimovig coverage by Presbyterian Healthcare Services, denial reasons, ways to secure coverage, Aimovig costs without insurance, and an informative FAQ.

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