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CGRPs (calcitonin-gene-related peptide)

Adventures in Insurance (with a happy ending!)

  • By Anonymous

    I have been thrilled beyond words with the difference Aimovig has made in my life, but there was still a hurdle to clear, and that was insurance coverage. I started my 2 month free trial and requested paperwork from my ins. company since they said it required preauthorization. They said they faxed it to my doctor, and for a few weeks we played a game of the doctor’s office saying they never received it and the insurance company saying they sent it. Finally, after the third round of faxing, the doctor had it and sent it back. I waited a week as instructed and when I checked with the insurance company I was notified that they had made their decision: denied. Ok, so the reason was that I hadn’t been diagnosed with chronic migraines. Flashback to my diagnosis in the early 1990s…ummm…ok. After looking further, I could see they wanted a definition of chronic that included 15+ headache days per month, 8 of which were migraines. No problem there! So after I played the fax game a couple more times, I just went in and had him fill out the form with that info.

    This morning I figured it had been long enough so I jumped in the chat box with the insurance company. Have you made a decision? Yes. Denied. WHY, I wanted to know? They said it wasn’t medically necessary and again listed the 15+ headache requirement. I (and I’m losing my sense of humor by now) said I know he wrote that because I WATCHED HIM DO IT! Then there was a bunch of stuff about trying a certain number of alternatives for a certain number of months. AND it was an experimental drug. I got mad (although I was nice to the rep because it wasn’t his fault) and said look, I have suffered for 30 years and this has changed my life and I am not going back! He said I could provide more information and they would reconsider.

    I was distraught so I called the folks with the Aimovig Ally program, and got the nicest guy. I told him of my plight (and threw in there that I was not going back to that pain again), and he put me on hold for a couple of minutes. When he came back on the line, he said he had spoken with the ins. company and it was approved as a Tier 4 drug, and my co-pay would be $225 a month! I asked him why in the heck am I being put through the ringer when I call and he said he didn’t know, but assured me that he just talked to them and it was covered. He also told me that I had 2 refills I didn’t even know I had and he would transfer my RX to my local pharmacy. I had checked with them last week and although they don’t stock it yet, they can order it without a problem.

    So I thanked him so much and he said if I had time he would ask me a few questions to see if I qualified for their co-pay program. I said sure. Then he put me on hold again after I answered the questions. When he came back he said a letter with this info would be coming, but to write down these numbers, which would give me my discount through their program. Then he said, “Ok, your co-pay through May of 2019 is $5.”

    So after all of this story, if anyone is having insurance trouble, I would call Aimovig Ally because things might be a lot better than you think. I know there are some restrictions on the program, but it’s definitely worth a shot.

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  • By Nancy Harris Bonk Moderator

    Hi Anonymous,

    Thank you so much for sharing that with us. I’m thrilled to hear the maker of Aimvog was so helpful and you’re all set through 2019.

    Keep us posted on how you are doing,
    Nancy

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    • By Drea99

      Aimovig has made a huge difference for me! I’ve been on it for a month so far. I was having migraines everyday for the last several months. I still get some mild pre-migraine symptoms, but they can be alleviated with Advil or Tylenol! No full blown migraines so far!!! I would encourage people to sign up for all of the programs and see what you qualify for. My insurance hasn’t decided yet so I did the free trial and then the bridge program until they do. Fingers crossed…it’s the only thing that’s truly helped me.

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  • By Andrea

    I’m supposed to get at least a 2 month supply (while my headache center is working with my insurance company to get extended approval). My headache center told me that the manufacturers of Amovig didn’t expect such an enormous response and there is a delay in getting the medication, because they can’t keep up with the demand. I filled out the forms 2 weeks ago and at that point was told I would get the medication in about 4 weeks.

    Has anyone else heard this?

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    • By Nancy Harris Bonk Moderator

      Hi Andrea,

      It’s true – the manufacturer didn’t seem to comprehend the vast need for this medication, which is astonishing to me. There are some delays for folks getting this medication.

      Keep us posted on how you are making out.

      Nancy

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  • By 757Dave

    Long time reader here at migraine.com, but just registered so that I could share my good news.

    I am 66 yo and have a diagnosis of chronic migraine. Just like so many others nothing has really given me relief.

    My medicare Rx plan with United Health Care has approved me for Aimovig. Got a call from them this past Thursday. My Neurologist/Migraine Specialist responded to all the paperwork that they sent to him and they will now cover the Rx.

    Thought this might help some.

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  • By Andrea

    Finally!. The Amovig arrived on Friday. I have an appointment with my headache specialist later this morning, so I’m going to take it with me so she can show me how to use it properly. Had a little glitch where I called them, was on hold for 45 minutes and they informed me that my doctor didn’t fill out the script correctly so she had to re-fax it, but the was taken care of. I hope that it helps me. I had a stroke earlier this year, so I can no longer use triptans or NSAIDS.

    Thanks everyone.

    Andrea

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  • By beachbumgirl

    Hi Andrea-
    I’m looking forward to hearing your story about your first injection. I had mine 27 days ago. I go back to my headache specialist on 8/23/18 for my second shot.

    Best wishes for headache freedom.

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  • By Andrea

    Hi Everyone

    I had my first injection of Amovig at my headache specialist’s office on this past Monday, 8/20/18. I also got nerve block injections and trigger point injections the same day, which I get every two weeks which I find helpful. I’m crossing my fingers because I can hear the rain outside my window and that is one of my major triggers (when the barometric pressure drops) and so far so good!

    From what I understand about my insurance coverage after I receive my second free injection is that I will be covered under Amovig’s Bridge program. My insurance is United Healthcare commercial insurance (UHC) and initially they were adamant they would not make a decision about coverage either way because they were still reviewing it. However, I also work for UHC as a psychiatric social worker (please don’t think I get any special favors – at this time they denied an increase in the dosage of an antidepressant). However because I have multiple medical diagnoses and am prescribed multiple medications, I’m followed by a Nurse Care Advocate (NCA). She went to bat for me.

    As I understood it (and I may be wrong), McKessen (the speciality pharmacy for Amovig) typically needs to receive a letter of denial from the insurance company before an individual is eligible for the Bridge program. In my case, my
    NCA got UHC and Mckessen to agree to enroll me in the Bridge program without the letter of denial. McKessen will be aware that my case will still fall under the UHC umbrella while the medication remains under review by UHC. This arrangement is in place for the 180 days following the 2nd free shipment of the Amovig.

    After that I can only hope that UHC approves the Amovig.

    Good luck to everyone else. Can’t wait to hear about your experience.

    Andrea

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  • By Andrea

    Hi Everyone

    I had my first injection of Amovig on 8/20/18 – actually two injections for the higher dose and I’ve only had one migraine since and that I can attribute to a nebulizer treatment which contained the medication Albuterol, which is a known trigger. I was admitted to the hospital this past weekend and the doctor ordered the treatment for me and I didn’t think to ask about the albuterol because I was sick. There are other options. It has rained here in the Northeast, which is usually a trigger I can’t control and I didn’t get a migraine 🙂 The same day I did the Amovig, I also got nerve block and trigger point injections which I’ve been getting every two weeks for years. They help, but not to this extent. Still holding my breath. Been disappointed too many times.

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    • By lsh5id

      I live in Ireland and aimovig (cgrp) willnot be here till end of 2019. If i could afford £500 per month I could get it in UK . At this stage I am desperate for something to take pain away. I would like to know how people on cgrp are feeling. In 2 weeks going into hospital for a total knee replacement so could not travel anyway.
      Joan

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    • By Nancy Harris Bonk Moderator

      Hi Joan,

      Good luck with your knee replacement!

      If you read through this thread, you’ll be able to see how people are responding to Aimovig.

      Let me know how your surgery goes.
      Nancy

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