Does Medicare cover Aimovig?

In this article:

• How much does Aimovig cost?
• Does Medicare cover Aimovig?
• How to save on Aimovig

In this article

• How much does Aimovig cost?
• Does Medicare cover Aimovig?
• How to save on Aimovig

Anyone who gets migraine attacks knows they can be debilitating. The throbbing, nausea, distorted vision, and sensitivity to light can render a person couch-bound and pleading for relief. For some, Aimovig (erenumab-aooe) can be a big help. This brand-name once-monthly injectable biologic medication targets a migraine catalyst called calcitonin gene-related peptide (CGRP) to help prevent future attacks. Aimovig’s price depends on where you get it and, most importantly, insurance or Medicare coverage. Medicare often covers it, but that depends on the specific plan. 

How much does Aimovig cost?

For anyone paying completely out of pocket—without insurance coverage or help from Medicare—Aimovig costs an average of $1,064 per 140 mg/mL autoinjector. It’s a once-monthly injection, so that means a year’s worth of Aimovig treatment would cost over $12,000. There’s no biosimilar alternative—which are often less expensive. “With a patent that will not expire until 2031 at the earliest (patent extensions are common), the cost is unlikely to decrease anytime soon,” says Tanya Feke, MD, a health policy analyst.

Yet that price isn’t set in stone. Insurance coverage and financial assistance programs are available. And retail prices can vary greatly by pharmacy. The pharmaceutical supply chain is a complex structure that involves not just pharmacies but manufacturers, wholesalers, pharmacy benefit managers, and insurance companies.

While pharmaceutical companies set prices for their drugs, negotiations happen at almost every level, which is why “prices can vary depending on the pharmacy. Some pharmacies may have negotiated better prices with suppliers, leading to lower costs for consumers,” according to Ojas Doshi, a product development scientist in the pharmaceutical industry. Sometimes, prices between pharmacies can vary by hundreds of dollars.

Does Medicare cover Aimovig?

In many cases, yes, Medicare will cover Aimovig. But only under certain Part D or Medicare Advantage plans. “Since Aimovig is an injectable drug typically administered at home, it would likely be covered under Part D plans,” Doshi says. Medicare Part D includes standalone prescription drug plans that Medicare beneficiaries can add to their existing Part A or Part B coverage.

Original Medicare (Parts A and B) doesn’t cover a wide range of outpatient prescription drugs, but “if Aimovig is administered in a doctor’s office rather than at home, it could be covered under Medicare Part B, which handles outpatient services,” Doshi says. “However, this is less common for Aimovig, as it is primarily designed for self-administration.”

Some Part D or Medicare Advantage plans, however, may need prior authorization before issuing coverage, according to Dr. Feke, who adds that insurers may ask for a few things before covering Aimovig due to the high price of the drug, including:

• Confirmation that the headaches are, in fact, migraine and not another kind of headache, like a tension headache
• The frequency of headaches
• Documentation that shows what medications patients have tried before, how long they tried them, and how effective they were

Essentially, the healthcare provider may have to prove Aimovig is medically necessary. 

“They may also require patients to try other, cheaper drugs before they can get them on Aimovig,” says Michael O. McKinney, MD, primary physician at Healthy Outlook. This is called step therapy. After reviewing these documents and attempts, Medicare will determine whether it will cover the Aimovig prescription.

Plus, keep in mind that the Food and Drug Administration (FDA) has only approved Aimovig for the prevention of migraine, but some doctors may prescribe it off-label for cluster headaches or vestibular migraine. Since the FDA hasn’t officially approved it for those conditions, some plans may refuse to cover these cases.

The easiest way to find out if your Medicare Part D plan covers Aimovig is to check the formulary, which is a drug list that shows how it classifies various medications. Formularies will often organize covered drugs into tiers, with generics in the lowest tier and more specialty or brand-name drugs in the higher ones. The lower the tier, the less you’ll typically pay.

How much does Aimovig cost on Medicare?

This can also vary significantly based on your Medicare plan, your condition, and several other factors. The manufacturer of Aimovig, Amgen Inc., provides some guidance. It says 69% of Aimovig prescriptions cost Medicare beneficiaries $20 or less and that the other 31% cost an average of $117. Those numbers refer to patients whose plans cover Aimovig, so if yours doesn’t, they won’t apply.

Many times, expenses depend on how a specific Medicare plan classifies Aimovig. “Tier placement can affect patients’ out-of-pocket costs,” Dr. McKinney says. “Often, there are high copays or coinsurance when Aimovig appears in a higher-tier category.”

Other factors influencing how much you pay include what phase of Part D coverage you are in—whether it’s the deductible phase, initial coverage phase, coverage gap (donut hole), or catastrophic phase.

Anyone enrolled in Medicaid might save even more. Amgen says 99% of Medicaid recipients pay $10 or less per month, and the remaining 1% pay $128 per month, on average. People who qualify for Medicare’s Low-Income Subsidy, known as Extra Help, will also pay less.

How to save on Aimovig

Even without Medicare coverage, it’s possible to bring down AImovig’s out-of-pocket costs—sometimes pretty significantly. Here are a few of the most common ways to save on Aimovig:

• Use a SingleCare discount card. The free discounts from SingleCare can take around $300 off the price of your Aimovig prescription, depending on your pharmacy and geographic location. Anyone can sign up for SingleCare, even if you have Medicare Part D. Just know you can’t stack SingleCare discounts on top of Medicare coverage. You’ll have to choose one or the other.

• Get help from the Amgen Safety Net Foundation. Through its patient support program, Amgen provides free medications for patients who need help paying for their prescriptions. You might be eligible if you have Medicare Part D but still can’t afford the out-of-pocket costs—as long as you meet certain income requirements. Check your eligibility on the Amgen Safety Net Foundation website.

• Ask about alternatives. Direct alternatives to Aimovig—other CGRP antagonists like Emgality and Ajovy—might come at a similar price. But insurance and Medicare plans may be more open to covering one over the other. Additionally, CGRP antagonists aren’t the only way to prevent migraine, and your healthcare provider might have recommendations for other, less expensive options. However, other medications might help treat migraine symptoms after they begin rather than prevent them, as Aimovig does.

• Consider private health insurance. Commercial insurance plans won’t always have better or more comprehensive prescription drug coverage than Medicare Part D, but some might. During the next open or special enrollment period, you might consider a separate or supplemental health plan to help pay for your medications.

• Apply for Medicaid or Medicare Extra Help. Medicaid is a joint federal and state program that provides additional support for Medicare beneficiaries who need it. Eligibility requirements vary by state, so check your state’s enrollment procedures to learn how to apply. Medicare also has a program called Extra Help, which offers financial assistance for Part D premiums, copays, coinsurance, deductibles, and other costs. You automatically get Extra Help if you enroll in Medicaid, but you can also apply separately through the Social Security Administration.

Medicare coverage varies by plan, but most Part D plans cover Aimovig