Does Tufts Health Plan Cover Aimovig

Discover if Tufts Health Plan covers Aimovig, tackle coverage denials, learn about costs without insurance, and find answers to common Aimovig questions.
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“Curex is changing the landscape of allergies in 2024”
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Tufts Health Plan Coverage for Aimovig

 

  • Coverage for Aimovig under Tufts Health Plan varies and is generally available to members diagnosed with chronic or episodic migraines.
  •  

  • The plan may require prior authorization. This helps ensure that Aimovig is medically necessary and prescribed according to clinical guidelines.
  •  

  • Typically, members must have tried and failed other preventive therapies before getting approval for Aimovig.
  •  

  • Health providers might need to submit documentation detailing medical history and previous treatments attempted by the patient.
  •  

  • Coverage terms can vary, so it's essential for members to check specific plan details or contact Tufts directly for the most accurate information.

 

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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 Tufts Health Plan

 

Contact Tufts Health Plan Customer Service

 

  • Reach out to Tufts customer service to confirm your specific plan covers Aimovig.
  •  

  • Ask about any required forms or steps needed to begin the coverage process.

 

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Aimovig based on your condition.
  •  

  • Ensure your healthcare provider is familiar with any documentation requirements that Tufts Health Plan may have.

 

 

Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Tufts Health Plan, which may be necessary for Aimovig coverage.
  •  

  • Include all required medical documentation, such as your diagnosis and treatment history, to support the request.

 

 

Check for Approved Pharmacies

 

  • Verify with Tufts Health Plan if there are approved pharmacies that you must use to obtain Aimovig.
  •  

  • Inquire if there are specific mail-order pharmacy options for greater convenience.

 

 

Review Your Plan's Drug Formulary

 

  • Access the latest drug formulary of your Tufts Health Plan to ensure Aimovig is listed and identify its tier level.
  •  

  • Understand the copayment or coinsurance amounts you may need to pay under your plan.

 

 

Verify Prescription Benefits

 

  • Confirm the details of your prescription drug benefits specific to Aimovig with Tufts Health Plan.
  •  

  • Ask about any step therapy or quantity limits applicable to Aimovig.

 

 

Appeal if Necessary

 

  • If your prior authorization is denied, discuss the options for appeal with your healthcare provider.
  •  

  • Prepare and submit a formal appeal to Tufts Health Plan with any additional supporting documentation.

 

 

Regularly Follow Up

 

  • Stay in contact with both Tufts Health Plan and your healthcare provider's office to track the progress of your coverage request.
  •  

  • Keep detailed records of all communications and submissions in case future issues arise.

 

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Does Tufts Health Plan Cover Aimovig

Discover if Tufts Health Plan covers Aimovig, tackle coverage denials, learn about costs without insurance, and find answers to common Aimovig questions.
Curex allergy drops unboxing

Is Aimovig Covered by Tufts Health Plan

 

Tufts Health Plan Coverage for Aimovig

 

  • Coverage for Aimovig under Tufts Health Plan varies and is generally available to members diagnosed with chronic or episodic migraines.
  •  

  • The plan may require prior authorization. This helps ensure that Aimovig is medically necessary and prescribed according to clinical guidelines.
  •  

  • Typically, members must have tried and failed other preventive therapies before getting approval for Aimovig.
  •  

  • Health providers might need to submit documentation detailing medical history and previous treatments attempted by the patient.
  •  

  • Coverage terms can vary, so it's essential for members to check specific plan details or contact Tufts directly for the most accurate information.

 

A weight management program tailored to you

Start with Curex

Tufts Health Plan's Approved Criteria for Aimovig Coverage

 

Criteria for Aimovig Coverage by Tufts Health Plan

 

  • Patient has a diagnosis of migraine, verified by a healthcare professional specializing in neurology or headache treatment.
  •  

  • Documentation indicates that the patient experiences at least 4 migraine days per month.
  •  

  • The healthcare provider has submitted evidence that alternative preventive treatments have been tried and did not provide adequate relief or were not tolerated by the patient.
  •  

  • The prescribing healthcare provider is either a neurologist, headache specialist, or physician with relevant expertise in treating migraines with Aimovig.
  •  

  • Patient must be 18 years of age or older as the safety and efficacy of Aimovig have not been established in pediatric patients.
  •  

  • Approval for Aimovig will be for the dosage as specified on the FDA-approved drug labeling, which is typically 70 mg once monthly, with consideration for 140 mg if clinically indicated and supported with documentation.
  •  

  • Reauthorization requires evidence of clinical benefit from Aimovig use, such as a decrease in the number of migraine days or improvement in quality of life.
  •  

  • Initial approval is often granted for a period of 3 to 6 months, followed by renewals if criteria are continuously met and documented improvements are maintained.

 

Additional Requirements

 

  • Prescriber's office must submit a detailed treatment plan addressing the long-term management of the patient's condition.
  •  

  • If the patient has other comorbid conditions, the prescriber must confirm that Aimovig is not contraindicated with their current treatment regimen.
  •  

  • Provider may need to submit periodic migraine diaries or similar documentation to assess the long-term effectiveness of Aimovig treatment.

 

Why Tufts Health Plan Might Deny Aimovig Coverage

 

Exclusion Criteria for Aimovig Coverage by Tufts Health Plan

 

  • Aimovig is not covered if the member does not meet the diagnostic criteria for chronic migraine.
  •  

  • Coverage is denied if the patient has not previously tried and failed at least one other preventive migraine treatment, such as antiepileptic drugs or beta blockers, unless there is a documented contraindication or intolerance to these treatments.
  •  

  • Aimovig is excluded under the plan for off-label uses that have not been substantiated by clinical evidence or established guidelines.
  •  

  • Coverage may be denied if the prescribed dosage exceeds the FDA-approved recommendations for Aimovig.
  •  

  • The plan does not cover Aimovig if it is requested for treatment of patients under the age that has been approved by the relevant health authorities.
  •  

  • Aimovig is not covered for patients who have not adhered to prescribed migraine treatments previously, as verified by pharmacy records or patient attestations.

 

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 Tufts Health Plan

 

Contact Tufts Health Plan Customer Service

 

  • Reach out to Tufts customer service to confirm your specific plan covers Aimovig.
  •  

  • Ask about any required forms or steps needed to begin the coverage process.

 

 

Consult with Your Healthcare Provider

 

  • Discuss with your healthcare provider the medical necessity for Aimovig based on your condition.
  •  

  • Ensure your healthcare provider is familiar with any documentation requirements that Tufts Health Plan may have.

 

 

Prior Authorization

 

  • Work with your healthcare provider to submit a prior authorization request to Tufts Health Plan, which may be necessary for Aimovig coverage.
  •  

  • Include all required medical documentation, such as your diagnosis and treatment history, to support the request.

 

 

Check for Approved Pharmacies

 

  • Verify with Tufts Health Plan if there are approved pharmacies that you must use to obtain Aimovig.
  •  

  • Inquire if there are specific mail-order pharmacy options for greater convenience.

 

 

Review Your Plan's Drug Formulary

 

  • Access the latest drug formulary of your Tufts Health Plan to ensure Aimovig is listed and identify its tier level.
  •  

  • Understand the copayment or coinsurance amounts you may need to pay under your plan.

 

 

Verify Prescription Benefits

 

  • Confirm the details of your prescription drug benefits specific to Aimovig with Tufts Health Plan.
  •  

  • Ask about any step therapy or quantity limits applicable to Aimovig.

 

 

Appeal if Necessary

 

  • If your prior authorization is denied, discuss the options for appeal with your healthcare provider.
  •  

  • Prepare and submit a formal appeal to Tufts Health Plan with any additional supporting documentation.

 

 

Regularly Follow Up

 

  • Stay in contact with both Tufts Health Plan and your healthcare provider's office to track the progress of your coverage request.
  •  

  • Keep detailed records of all communications and submissions in case future issues arise.

 

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 Tufts Health Plan Cover Aimovig

Discover if Tufts Health Plan covers Aimovig, tackle coverage denials, learn about costs without insurance, and find answers to common Aimovig questions.
Curex allergy drops unboxing

Does Tufts Health Plan Cover Aimovig

 

Tufts Health Plan Coverage for Aimovig

 

  • Coverage for Aimovig under Tufts Health Plan varies and is generally available to members diagnosed with chronic or episodic migraines.
  •  

  • The plan may require prior authorization. This helps ensure that Aimovig is medically necessary and prescribed according to clinical guidelines.
  •  

  • Typically, members must have tried and failed other preventive therapies before getting approval for Aimovig.
  •  

  • Health providers might need to submit documentation detailing medical history and previous treatments attempted by the patient.
  •  

  • Coverage terms can vary, so it's essential for members to check specific plan details or contact Tufts directly for the most accurate information.

 

A weight management program tailored to you

Start with Curex

Why Tufts Health Plan Might Deny Aimovig Coverage

 

Criteria for Aimovig Coverage by Tufts Health Plan

 

  • Patient has a diagnosis of migraine, verified by a healthcare professional specializing in neurology or headache treatment.
  •  

  • Documentation indicates that the patient experiences at least 4 migraine days per month.
  •  

  • The healthcare provider has submitted evidence that alternative preventive treatments have been tried and did not provide adequate relief or were not tolerated by the patient.
  •  

  • The prescribing healthcare provider is either a neurologist, headache specialist, or physician with relevant expertise in treating migraines with Aimovig.
  •  

  • Patient must be 18 years of age or older as the safety and efficacy of Aimovig have not been established in pediatric patients.
  •  

  • Approval for Aimovig will be for the dosage as specified on the FDA-approved drug labeling, which is typically 70 mg once monthly, with consideration for 140 mg if clinically indicated and supported with documentation.
  •  

  • Reauthorization requires evidence of clinical benefit from Aimovig use, such as a decrease in the number of migraine days or improvement in quality of life.
  •  

  • Initial approval is often granted for a period of 3 to 6 months, followed by renewals if criteria are continuously met and documented improvements are maintained.

 

Additional Requirements

 

  • Prescriber's office must submit a detailed treatment plan addressing the long-term management of the patient's condition.
  •  

  • If the patient has other comorbid conditions, the prescriber must confirm that Aimovig is not contraindicated with their current treatment regimen.
  •  

  • Provider may need to submit periodic migraine diaries or similar documentation to assess the long-term effectiveness of Aimovig treatment.

 

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

Aimovig FAQ

 

Exclusion Criteria for Aimovig Coverage by Tufts Health Plan

 

  • Aimovig is not covered if the member does not meet the diagnostic criteria for chronic migraine.
  •  

  • Coverage is denied if the patient has not previously tried and failed at least one other preventive migraine treatment, such as antiepileptic drugs or beta blockers, unless there is a documented contraindication or intolerance to these treatments.
  •  

  • Aimovig is excluded under the plan for off-label uses that have not been substantiated by clinical evidence or established guidelines.
  •  

  • Coverage may be denied if the prescribed dosage exceeds the FDA-approved recommendations for Aimovig.
  •  

  • The plan does not cover Aimovig if it is requested for treatment of patients under the age that has been approved by the relevant health authorities.
  •  

  • Aimovig is not covered for patients who have not adhered to prescribed migraine treatments previously, as verified by pharmacy records or patient attestations.

 

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.