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Does Quartz Health Solutions Cover Aimovig

Explore Aimovig coverage with Quartz Health Solutions: potential denials, costs without insurance, and FAQs. Get the insights you need on securing coverage.

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Does Quartz Health Solutions Cover Aimovig?

Quartz Health Solutions may cover Aimovig, a medication used to prevent migraines, under specific circumstances. Coverage often depends on the plan type and individual medical requirements.

To get Aimovig covered, a patient may need a documented diagnosis of chronic migraines, typically defined as having 15 or more headache days per month over a prolonged period.

Patients might need to demonstrate insufficient responses to other migraine treatments before getting approval for Aimovig. A trial and failure of at least two generic migraine treatments are generally required.

Prior authorization from Quartz is often necessary. This process includes a review of the patient's medical history and previous treatments.

Patients should consult with their healthcare provider and Quartz’s member services for detailed and personalized information regarding coverage and criteria.

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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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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 Quartz Health Solutions

Check Quartz Health Solutions Policy for Aimovig Coverage

Review Quartz Health Solutions' pharmacy benefits to confirm Aimovig coverage. This information can typically be found in the policy documents provided by Quartz.
Contact Quartz customer service directly for reassurance and any specific coverage details related to Aimovig.

Consult with Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your condition. Ensure they are aware that you are seeking coverage through Quartz.
Request your healthcare provider to prepare any necessary documentation or justification for the use of Aimovig, which may be required for prior authorization.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Quartz Health Solutions. This request often includes medical records, history of previous treatments, and a statement of medical necessity.
Ensure that all forms and documents are filled out correctly and comprehensively to prevent delays in processing the request.

Follow Up on the Authorization

Regularly check the status of your prior authorization request with Quartz. This can typically be done through their customer service or member portal.
Be proactive in providing any additional information requested by Quartz to expedite the approval process.

Understand Appeals Process If Needed

If your initial request for prior authorization is denied, review the reason for denial provided by Quartz. Your healthcare provider can help understand and address the reasons for denial.
Submit an appeal with additional supporting documentation or a revised statement of medical necessity, if necessary.
Consider reaching out to a patient advocacy group for assistance with the appeal process if your appeal is denied.

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FAQs

Does Quartz Health Solutions Cover Aimovig

Explore Aimovig coverage with Quartz Health Solutions: potential denials, costs without insurance, and FAQs. Get the insights you need on securing coverage.

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Is Aimovig Covered by Quartz Health Solutions

Does Quartz Health Solutions Cover Aimovig?

Quartz Health Solutions may cover Aimovig, a medication used to prevent migraines, under specific circumstances. Coverage often depends on the plan type and individual medical requirements.

To get Aimovig covered, a patient may need a documented diagnosis of chronic migraines, typically defined as having 15 or more headache days per month over a prolonged period.

Patients might need to demonstrate insufficient responses to other migraine treatments before getting approval for Aimovig. A trial and failure of at least two generic migraine treatments are generally required.

Prior authorization from Quartz is often necessary. This process includes a review of the patient's medical history and previous treatments.

Patients should consult with their healthcare provider and Quartz’s member services for detailed and personalized information regarding coverage and criteria.

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Quartz Health Solutions's Approved Criteria for Aimovig Coverage

Criteria for Aimovig Coverage by Quartz Health Solutions

**Diagnosis of Chronic Migraine**: Member must have a documented diagnosis of chronic migraine, defined as experiencing 15 or more headache days per month for at least 3 months, with at least 8 of those days associated with migraine.

**Prior Therapies**: Member must have tried and failed at least two of the following preventive migraine therapies, unless contraindicated or not tolerated:
- Topiramate or another anticonvulsant medication
- Beta-blockers (e.g., propranolol, metoprolol)
- Tricyclic antidepressants (e.g., amitriptyline)

**Documentation and Evaluation**: Healthcare provider must provide detailed documentation of the member's migraine history, including frequency, severity, and current treatment outcomes. An evaluation by a neurologist or a headache specialist may be required.

**Continued Therapy Evaluation**: Coverage for continued Aimovig therapy requires evidence of clinically significant improvement, such as a reduction in migraine frequency or severity. Re-evaluation may be required every 6 months.

**Age Limitations**: Member must be 18 years of age or older to qualify for Aimovig coverage.

**Dosing Requirements**: Aimovig must be prescribed within the FDA-approved dosing guidelines, and any use of higher dosage must be fully justified by clinical evidence and be within established treatment protocols.

Why Quartz Health Solutions Might Deny Aimovig Coverage

Situations Where Quartz Health Solutions Might Deny Aimovig Coverage

Aimovig is prescribed for a condition not recognized as medically necessary within their policy guidelines.

The patient does not meet the specific diagnostic criteria required for Aimovig coverage, such as frequency or severity of migraine attacks.

Lack of prior authorization from Quartz Health Solutions before initiating treatment with Aimovig, if it is a required process under the policy.

Aimovig is prescribed at a dosage or quantity not approved by Quartz Health Solutions' formulary guidelines.

The prescription is issued by a healthcare provider not within the Quartz Health Solutions network, without prior authorization for out-of-network services.

Failure to provide documentation of unsuccessful previous treatments with standard therapies, if required as part of the coverage criteria.

Use of Aimovig for an off-label purpose not covered under the policy terms of Quartz Health Solutions.

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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 Quartz Health Solutions

Check Quartz Health Solutions Policy for Aimovig Coverage

Review Quartz Health Solutions' pharmacy benefits to confirm Aimovig coverage. This information can typically be found in the policy documents provided by Quartz.
Contact Quartz customer service directly for reassurance and any specific coverage details related to Aimovig.

Consult with Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your condition. Ensure they are aware that you are seeking coverage through Quartz.
Request your healthcare provider to prepare any necessary documentation or justification for the use of Aimovig, which may be required for prior authorization.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to Quartz Health Solutions. This request often includes medical records, history of previous treatments, and a statement of medical necessity.
Ensure that all forms and documents are filled out correctly and comprehensively to prevent delays in processing the request.

Follow Up on the Authorization

Regularly check the status of your prior authorization request with Quartz. This can typically be done through their customer service or member portal.
Be proactive in providing any additional information requested by Quartz to expedite the approval process.

Understand Appeals Process If Needed

If your initial request for prior authorization is denied, review the reason for denial provided by Quartz. Your healthcare provider can help understand and address the reasons for denial.
Submit an appeal with additional supporting documentation or a revised statement of medical necessity, if necessary.
Consider reaching out to a patient advocacy group for assistance with the appeal process if your appeal is denied.

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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.

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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 Quartz Health Solutions Cover Aimovig

Explore Aimovig coverage with Quartz Health Solutions: potential denials, costs without insurance, and FAQs. Get the insights you need on securing coverage.

Achieve Your Goals Faster with Curex