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Does WellCare Cover Aimovig

Explore WellCare coverage for Aimovig, reasons for denial, obtaining coverage, costs without insurance, and answers to common questions in this detailed guide.

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Does WellCare Cover Aimovig?

Coverage for Aimovig under WellCare can vary based on the specific plan and location. Aimovig is typically covered when prescribed for chronic migraine prevention.

A prior authorization may be required, meaning your healthcare provider needs to demonstrate medical necessity.

General criteria include a diagnosis of chronic migraines, typically defined as 15 or more headache days per month lasting at least 4 hours each.

Patients may need to have tried other therapeutic options without success before Aimovig is approved.

It's crucial to check with WellCare directly or consult your plan information to verify the specific details related to your policy.

Work with your healthcare provider to submit the necessary documentation to meet WellCare's requirements for Aimovig 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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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 WellCare

Review Your WellCare Plan Details

Check your WellCare plan to determine if Aimovig is covered. You can find this information in the plan's formulary, which lists all covered medications.

Contact a WellCare customer service representative to clarify questions regarding Aimovig coverage and any required steps for obtaining it. They can provide specific guidance according to your plan.

Consult Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your treatment plan. Ensure they are aware of your intention to have it covered by WellCare.

Your provider may need to document the medical necessity for Aimovig if additional justification is required for insurance purposes.

Acquire a Prescription

Have your healthcare provider write a prescription for Aimovig. Ensure all details are correct, as errors can lead to processing delays with insurance.

Some insurance plans may require a prior authorization form to be submitted along with the prescription, so check if this is necessary.

Submit a Prior Authorization, if Necessary

If WellCare requires a prior authorization, your healthcare provider will need to complete and submit this form. This process involves justifying the medical necessity of Aimovig.

Coordinate with your provider to ensure all required documentation is submitted promptly to avoid delays. The submission typically includes your medical records and the treatment rationale.

Follow Up on the Authorization Process

Contact WellCare to confirm they received the prior authorization and inquire about the approval status. It may take some time, so regular follow-ups could be beneficial.

Be prepared to provide additional information if requested by WellCare during their review process.

Reach Out to Aimovig Ally (Optional)

Consider contacting Aimovig Ally, a patient support program, for additional assistance. They can offer help with navigating insurance coverage and understanding out-of-pocket costs.

They may provide financial assistance options if there are coverage gaps or high copays.

Receive and Fill Your Prescription

Once WellCare has approved the coverage, your prescription for Aimovig can be filled. Choose a pharmacy that works with WellCare to ensure a smooth transaction.

Check with the pharmacy to see if additional documentation or information is needed when filling the prescription for Aimovig.

Maintain Ongoing Communication

Keep open lines of communication with WellCare, your healthcare provider, and your pharmacist to swiftly address any issues that might arise during the treatment period.

Regularly review your WellCare plan to stay updated on any changes regarding medication coverage.

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Does WellCare Cover Aimovig

Explore WellCare coverage for Aimovig, reasons for denial, obtaining coverage, costs without insurance, and answers to common questions in this detailed guide.

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Is Aimovig Covered by WellCare

Does WellCare Cover Aimovig?

Coverage for Aimovig under WellCare can vary based on the specific plan and location. Aimovig is typically covered when prescribed for chronic migraine prevention.

A prior authorization may be required, meaning your healthcare provider needs to demonstrate medical necessity.

General criteria include a diagnosis of chronic migraines, typically defined as 15 or more headache days per month lasting at least 4 hours each.

Patients may need to have tried other therapeutic options without success before Aimovig is approved.

It's crucial to check with WellCare directly or consult your plan information to verify the specific details related to your policy.

Work with your healthcare provider to submit the necessary documentation to meet WellCare's requirements for Aimovig coverage.

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WellCare's Approved Criteria for Aimovig Coverage

WellCare's Approved Criteria for Aimovig Coverage

Aimovig may be covered for patients who are 18 years of age or older and have a documented diagnosis of migraine.

The patient must have a history of chronic migraine, defined as experiencing 15 or more headache days per month for more than 3 months, with at least 8 days being migraine days.

The patient has tried and failed at least two different classes of preventive migraine therapies, including beta blockers, anticonvulsants, or antidepressant medications, unless contraindicated or clinically not appropriate.

Aimovig coverage may be approved for patients who have an inadequate response, intolerance, or contraindication to at least two oral migraine preventive agents.

For ongoing coverage, documentation of a reduction in the frequency of migraine days or headache days from baseline is required after 3 months of Aimovig therapy.

The medication must be prescribed by a neurologist or a headache specialist for initial approval.

Why WellCare Might Deny Aimovig Coverage

Reasons for Denial of Aimovig Coverage by WellCare

The patient does not meet the clinical criteria for migraine prevention as specified by WellCare's policy.

There is a lack of documentation or insufficient proof of a previous trial and failure of or contraindication to other prophylactic migraine medications.

The request is for a dosage that is not within the approved dosing guidelines set by WellCare.

Use of Aimovig for conditions other than those specified in the WellCare coverage policy, such as for types of migraines that are not considered chronic or do not meet the defined frequency criteria.

Aimovig is not on the formulary, and the request for an exception has been denied, possibly due to the availability of therapeutically equivalent alternatives.

The coverage request does not include necessary prior authorization or lacks required health care provider documentation at the time of request submission.

The use of Aimovig is considered off-label and not supported by sufficient clinical evidence according to WellCare's evaluation.

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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 WellCare

Review Your WellCare Plan Details

Check your WellCare plan to determine if Aimovig is covered. You can find this information in the plan's formulary, which lists all covered medications.

Contact a WellCare customer service representative to clarify questions regarding Aimovig coverage and any required steps for obtaining it. They can provide specific guidance according to your plan.

Consult Your Healthcare Provider

Discuss with your healthcare provider the necessity of Aimovig for your treatment plan. Ensure they are aware of your intention to have it covered by WellCare.

Your provider may need to document the medical necessity for Aimovig if additional justification is required for insurance purposes.

Acquire a Prescription

Have your healthcare provider write a prescription for Aimovig. Ensure all details are correct, as errors can lead to processing delays with insurance.

Some insurance plans may require a prior authorization form to be submitted along with the prescription, so check if this is necessary.

Submit a Prior Authorization, if Necessary

If WellCare requires a prior authorization, your healthcare provider will need to complete and submit this form. This process involves justifying the medical necessity of Aimovig.

Coordinate with your provider to ensure all required documentation is submitted promptly to avoid delays. The submission typically includes your medical records and the treatment rationale.

Follow Up on the Authorization Process

Contact WellCare to confirm they received the prior authorization and inquire about the approval status. It may take some time, so regular follow-ups could be beneficial.

Be prepared to provide additional information if requested by WellCare during their review process.

Reach Out to Aimovig Ally (Optional)

Consider contacting Aimovig Ally, a patient support program, for additional assistance. They can offer help with navigating insurance coverage and understanding out-of-pocket costs.

They may provide financial assistance options if there are coverage gaps or high copays.

Receive and Fill Your Prescription

Once WellCare has approved the coverage, your prescription for Aimovig can be filled. Choose a pharmacy that works with WellCare to ensure a smooth transaction.

Check with the pharmacy to see if additional documentation or information is needed when filling the prescription for Aimovig.

Maintain Ongoing Communication

Keep open lines of communication with WellCare, your healthcare provider, and your pharmacist to swiftly address any issues that might arise during the treatment period.

Regularly review your WellCare plan to stay updated on any changes regarding medication 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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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 WellCare Cover Aimovig

Explore WellCare coverage for Aimovig, reasons for denial, obtaining coverage, costs without insurance, and answers to common questions in this detailed guide.

Achieve Your Goals Faster with Curex