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Does UPMC Health Plan Cover Aimovig

Explore Aimovig coverage with UPMC Health Plan: denial reasons, approval tips, out-of-pocket costs, and FAQs. Navigate insurance hurdles for migraine relief.

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Coverage for Aimovig

UPMC Health Plan may cover Aimovig for preventing migraine in adults.

Coverage often depends on having tried and failed two or more traditional preventive therapies.

Prior authorization is typically required to ensure medical necessity.

Criteria and Basic Rules

Documentation from a healthcare provider confirming diagnosis and previous treatments is usually necessary.

Patients may need to meet specific migraine frequency criteria, such as experiencing at least four migraine days per month.

Regular follow-ups or reassessments may be needed to continue coverage.

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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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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 UPMC Health Plan

Contact UPMC Health Plan Customer Service

Reach out to UPMC Health Plan customer service via the phone number provided on your insurance card. Explain your need for Aimovig and inquire about the steps and documentation required for coverage.
Ask for a list of in-network pharmacies and healthcare providers to ensure all aspects are covered by your plan.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Aimovig, ensuring that the condition is well-documented in your medical records.
Request a written prescription for Aimovig from your provider, as well as any necessary documentation that details your medical history and the need for this medication.

Check UPMC Health Plan Formulary

Review the UPMC Health Plan's formulary list to confirm whether Aimovig is covered. This can often be done online through the health plan’s website.
Take note of any special requirements or prerequisites for coverage such as prior authorization or step therapy protocols.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to UPMC Health Plan if required. This request should include your prescription, supporting medical documents, and a detailed explanation of your medical need for Aimovig.
Follow up with the insurance company to confirm they have received and are processing the request, as delays can occur.

Work with a Pharmacy

Choose an in-network pharmacy to fill your prescription. Your healthcare provider and UPMC Health Plan should be able to provide a list of suitable options.
Ensure that the pharmacy has all the necessary details to process the claim with UPMC Health Plan. They may require details of the prior authorization and your insurance information.

Appeal a Denied Claim

If your claim is denied, request detailed information on the reasons and take note of any additional documentation that may be required.
Work with your healthcare provider to gather any further evidence or explanation and submit an appeal to the insurance company.

Monitor and Follow Up

Regularly check the status of your claims and appeals. Promptly respond to any requests for further information from your healthcare provider or UPMC Health Plan.
Maintain records of all communications, paperwork, and responses regarding your Aimovig coverage to ensure a smooth process and have a reference if issues arise.

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FAQs

Does UPMC Health Plan Cover Aimovig

Explore Aimovig coverage with UPMC Health Plan: denial reasons, approval tips, out-of-pocket costs, and FAQs. Navigate insurance hurdles for migraine relief.

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Is Aimovig Covered by UPMC Health Plan

Coverage for Aimovig

UPMC Health Plan may cover Aimovig for preventing migraine in adults.

Coverage often depends on having tried and failed two or more traditional preventive therapies.

Prior authorization is typically required to ensure medical necessity.

Criteria and Basic Rules

Documentation from a healthcare provider confirming diagnosis and previous treatments is usually necessary.

Patients may need to meet specific migraine frequency criteria, such as experiencing at least four migraine days per month.

Regular follow-ups or reassessments may be needed to continue coverage.

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UPMC Health Plan's Approved Criteria for Aimovig Coverage

UPMC Health Plan's Approved Criteria for Aimovig Coverage

A diagnosis of migraine, confirmed by a healthcare provider, that necessitates preventive treatment.

The patient must have experienced a history of frequent episodic migraines or have chronic migraines, defined as having 15 or more headache days monthly for at least three months, eight of which must be migraine days.

Prior treatment must include trials and inadequate response, intolerance, or contraindication to at least two classes of oral migraine preventive medications, such as beta-blockers, anticonvulsants, or antidepressants.

Documentation of a structured headache diary or log to track migraine frequency and severity prior to starting Aimovig therapy and during treatment to assess effectiveness.

The patient must be at least 18 years old, as Aimovig is approved for use in adults only.

Explicit documentation from the healthcare provider stating the anticipated benefits of the plan and a treatment plan outline including dosing and administration schedule for Aimovig.

Regular follow-up assessments to evaluate Aimovig’s clinical efficacy, side effects, patient adherence, and potential necessity for continued therapy.

Why UPMC Health Plan Might Deny Aimovig Coverage

Non-Medical Necessity

Aimovig may be denied if it does not meet the plan's criteria for medical necessity. This generally means that alternative treatments should have been tried and failed or determined ineffective before approving Aimovig.

Formulary Restrictions

The drug might not be included in UPMC Health Plan's formulary, making it ineligible for coverage.

Incomplete Documentation

Requests lacking sufficient documentation, including detailed medical history or previous treatment failures, may be denied.

Out-of-Network Prescriptions

If a healthcare provider prescribing Aimovig is out of UPMC's network, coverage might be denied.

Non-Approved Use

Coverage may be denied if Aimovig is prescribed for a non-FDA-approved use, meaning it is off-label for the intended treatment.

Lack of Prior Authorization

If prior authorization requirements are not met, then coverage for Aimovig can be denied.

Non-Compliance with Plan Requirements

Coverage might also be denied if the member does not comply with specified health plan requirements or policies.

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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 UPMC Health Plan

Contact UPMC Health Plan Customer Service

Reach out to UPMC Health Plan customer service via the phone number provided on your insurance card. Explain your need for Aimovig and inquire about the steps and documentation required for coverage.
Ask for a list of in-network pharmacies and healthcare providers to ensure all aspects are covered by your plan.

Consult with Your Healthcare Provider

Schedule an appointment with your healthcare provider to discuss your need for Aimovig, ensuring that the condition is well-documented in your medical records.
Request a written prescription for Aimovig from your provider, as well as any necessary documentation that details your medical history and the need for this medication.

Check UPMC Health Plan Formulary

Review the UPMC Health Plan's formulary list to confirm whether Aimovig is covered. This can often be done online through the health plan’s website.
Take note of any special requirements or prerequisites for coverage such as prior authorization or step therapy protocols.

Submit a Prior Authorization Request

Work with your healthcare provider to submit a prior authorization request to UPMC Health Plan if required. This request should include your prescription, supporting medical documents, and a detailed explanation of your medical need for Aimovig.
Follow up with the insurance company to confirm they have received and are processing the request, as delays can occur.

Work with a Pharmacy

Choose an in-network pharmacy to fill your prescription. Your healthcare provider and UPMC Health Plan should be able to provide a list of suitable options.
Ensure that the pharmacy has all the necessary details to process the claim with UPMC Health Plan. They may require details of the prior authorization and your insurance information.

Appeal a Denied Claim

If your claim is denied, request detailed information on the reasons and take note of any additional documentation that may be required.
Work with your healthcare provider to gather any further evidence or explanation and submit an appeal to the insurance company.

Monitor and Follow Up

Regularly check the status of your claims and appeals. Promptly respond to any requests for further information from your healthcare provider or UPMC Health Plan.
Maintain records of all communications, paperwork, and responses regarding your Aimovig coverage to ensure a smooth process and have a reference if issues arise.

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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 UPMC Health Plan Cover Aimovig

Explore Aimovig coverage with UPMC Health Plan: denial reasons, approval tips, out-of-pocket costs, and FAQs. Navigate insurance hurdles for migraine relief.

Achieve Your Goals Faster with Curex