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Drug Info

Does Aetna cover Nurtec?

Learn what factors affect whether your Aetna plan will cover Nurtec ODT
Taneia Surles, MPH
By | Dec. 31, 2024 Medically reviewed by Jessica Swirble, Pharm.D.
A health insurance card and three pills: Does Aetna cover Nurtec?

Key takeaways

  • Nurtec ODT is a brand-name drug prescribed to treat or prevent migraines.

  • Aetna will typically cover Nurtec with prior authorization, but coverage varies by plan.

  • Depending on the copay your Aetna plan places Nurtec on, you may pay as little as $0 per fill.  

  • If your Aetna plan doesn’t cover Nurtec or your copay is too high, you can pursue other options to lower your cost, such as using a SingleCare coupon. 

In this article:

Nurtec ODT (rimegepant) is a brand-name antimigraine drug approved by the Food and Drug Administration (FDA) to treat acute migraines and prevent episodic migraines for adults. Healthcare providers will prescribe this medication to patients who have attempted other types of migraine management or are sensitive to other classes of drugs, such as serotonin-receptor agonists (triptans).

“Nurtec ODT is part of a class of drugs called calcitonin gene-related peptide receptor (CGRP) antagonists,” says Edmond Hakimi, DO, a dual-board-certified internal medicine physician and the medical director at Wellbridge in Calverton, New York. “The CGRP protein is involved in the inflammation and pain associated with migraines, and Nurtec works by blocking it. The medication is an orally disintegrating tablet that dissolves in the mouth without water, making it a convenient option for migraine relief.”

According to Dr. Hakimi, Nurtec is typically covered by insurance, but coverage can vary depending on your specific health insurance plan. 

Does Aetna cover Nurtec?

Yes, Aetna may cover Nurtec. However, not all Aetna plans are the same. Aetna offers many individual plans, corporate plans, Medicare plans, and Medicaid plans—all with varying degrees of coverage and drug formularies (lists of covered drugs). You can use Aetna’s medication lookup tool to find out whether your plan covers Nurtec and whether there are any requirements or restrictions.

Factors affecting Aetna’s converge of Nurtec

Pfizer, the manufacturer of Nurtec, says most insurance companies are likely to cover Nurtec. However, there may be some requirements patients and their healthcare providers must adhere to first. Many insurance companies require prior authorization. In this process, your healthcare provider will have to prove to Aetna that the medication is medically necessary. 

According to Dr. Hakimi, some insurance plans also require their insureds to complete step therapy before prescribing a medication. Step therapy, also known as “fail first,” is when an insurance company requires patients to try alternative, lower-cost medications for their medical conditions before moving to a more expensive drug.

Nurtec alternatives

If your Aetna plan recommends trying Nurtec alternatives before it will cover Nurtec, your healthcare provider may recommend any of the following, depending on your medical history and whether you’re using Nurtec to prevent migraine or to treat acute migraine:

Contact your healthcare provider to see if they can switch your prescription to one of the above-mentioned drug names to save money on your medications. 

How much does Nurtec cost?

If you can’t get prior authorization through Aetna, you may need to pay out-of-pocket for Nurtec ODT. The average retail price of one box of 8 disintegrating tablets is about $1,322 without insurance. Drug prices fluctuate, however, and vary by pharmacy. 

How much does Nurtec cost with Aetna?

Drug coverage for Nurtec ODT varies depending on your plan. To give you an example, for the 2024 Aetna Better Health Premier Plan, which is a Medicaid plan, Nurtec ODT (75 mg) is on Tier 2 with a $0 copay. However, prior authorization is required, and the quantity limit is 16 tablets for 30 days.

How to check whether your Aetna plan covers Nurtec 

Nurtec ODT coverage depends on what Aetna health insurance plan you have. You can look at your plan’s formulary to determine if you have coverage for this medication. As mentioned earlier, Aetna’s medicine search tool makes it easy to search through thousands of prescription medications to determine which ones are covered under your plan and exclusions of certain drugs. 

You can also log into the member website at Aetna.com to view the drug list for your plan in your Summary of Benefits and Coverage (SBC). If you need assistance navigating Aetna’s website, you can contact one of its representatives by dialing the phone number on the back of your insurance card. 

How to save on Nurtec

If you find that your Aetna plan doesn’t list Nurtec ODT as one of its covered drugs, there are other options you can pursue to lower your out-of-pocket costs. 

SingleCare can help you save money on Nurtec ODT if your copay for Nurtec is too high or it’s not one of your covered drugs. Savings vary by pharmacy, but you could pay $852 instead of $1,322 for one box of 8 orally disintegrating tablets. To find a SingleCare coupon, search for your preferred pharmacy on the Nurtec coupon page on SingleCare’s website and click “Get free coupon.” You’ll then receive a coupon to save to your phone or print. You’ll show this coupon card to your pharmacist to get your discount. 

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