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.