Is Aimovig covered by Medicaid?

In this article:

• Does Medicaid cover Aimovig?
• Factors influencing Medicaid coverage of Aimovig
• How much does Aimovig cost?
• Costs of Aimovig with Medicaid
• Ways to get discounts on Aimovig

In this article

• Does Medicaid cover Aimovig?
• Factors influencing Medicaid coverage of Aimovig
• How much does Aimovig cost?
• Costs of Aimovig with Medicaid
• Ways to get discounts on Aimovig

One moment, you’re ripping through your to-do list. The next, you’re floored by a migraine. Between the pain, sensitivity to light, nausea, and vision disturbances, migraines can derail an entire day and keep you bedridden for hours on end. That’s why Aimovig (erenumab-aooe) comes as such a reassurance. It’s the first prescription drug approved by the Food and Drug Administration (FDA) to prevent migraines before they strike, and clinical trials have proven its ability to reduce monthly migraine days.

That effectiveness doesn’t always come cheap, though. Fortunately, Medicaid may cover Aimovig, but coverage varies by state and plan. Here are the important details.

Does Medicaid cover Aimovig?

Most people who have some type of health insurance receive coverage for Aimovig. In fact, the manufacturer of Aimovig, Amgen Inc., says 87% of patients with a commercial insurance plan, Medicare, or Medicaid have coverage for Aimovig. However, Amgen doesn’t indicate just how much coverage these insured individuals receive.

Every plan is different, and states determine their own criteria for Medicaid coverage. So while one state’s Medicaid program may cover Aimovig, another’s may not. Chances are, Medicaid will cover it, but you’ll need to check your plan’s formulary to be sure.

RELATED: Does Medicare cover Aimovig?

Factors influencing Medicaid coverage of Aimovig 

Individuals who haven’t yet enrolled in Medicaid need to make sure they’re eligible first. Eligibility requirements vary by state, but qualified applicants typically need to have a household income below a certain threshold. The Centers for Medicare and Medicaid Services publishes state overviews, which you can use to find the income requirements and other details about your state’s Medicaid program. 

But let’s say you already have Medicaid, and your plan covers Aimovig. That’s a great start, but it doesn’t mean you’ll automatically get your medication for free. Not every plan covers it 100%, so you might still have copays, or you might need to meet a deductible before your coverage kicks in.

“In some cases, Aimovig is covered by Medicaid without contractual obligation but still may need prior approval through a formulary exception,” says John Lowe, MD, a physician in private practice in Ogden, Utah. This is called prior authorization, and depending on the plan, the prescribing healthcare provider may need to provide some documentation of the patient’s symptoms or other treatments they’ve tried. You may also have to complete step therapy, which means trying other medications before Aimovig.

The Aimovig dosage prescribed might play a role, too. “Certain plans can avoid providing coverage for certain strengths such as 70 mg or 140 mg monthly,” Dr. Lowe says.

All this information is available in your plan’s formulary, a list that shows how it covers each drug. These formularies typically classify the medications as preferred or nonpreferred. Preferred drugs are often covered more comprehensively, while nonpreferred ones are more likely to have prior authorization or step therapy requirements.

How much does Aimovig cost?

Without using insurance or Medicaid, the average out-of-pocket cost of Aimovig is around $1,031 per 1 mL of 140 mg/mL autoinjector pen. It’s a once-monthly subcutaneous injection, so each pen constitutes a one-month supply. Still, over the course of a full year, that full price can add up to over $12,000.

As a biologic medication, Aimovig can be expensive, but it’s important to note that $1,031 isn’t a set-in-stone price, and most people don’t pay that amount. Your Aimovig price could depend on the dosage prescribed as well as your location and pharmacy. Prices can change significantly between pharmacies, even ones in the same town.

Costs of Aimovig with Medicaid

Every prescription drug plan has policies on cost sharing—where the insurer pays a certain percentage and the beneficiary is responsible for the rest—in the form of copays and coinsurance. And plans can have different policies for different drugs.

Even though it’s a pricier brand-name drug, Amgen says 99% of Medicaid beneficiaries pay less than $10 per month in cost-sharing for their prescriptions, and the other 1% pay an average of $128. But again, it depends on the particular plan and state.

For example, Illinois’ preferred drug list (PDL) classifies Aimovig as a preferred drug that requires prior authorization, and the Medicaid copay for brand-name drugs is $3.90. By comparison, Florida lists Aimovig as a preferred drug, too, but it doesn’t require prior authorization and charges a maximum of $7.50 in coinsurance per prescription drug. Prices are subject to change.

Ways to get discounts on Aimovig

Many health plans might cover Aimovig, but it’s still not guaranteed, which might have you lining up your backup plans. Fortunately, there are a few other ways to save money.

One of the easiest ways to save is by using a SingleCare prescription discount card. Just show it to your pharmacist when you’re paying for your prescription. Savings vary by pharmacy, but you could pay $738 instead of $1,031 per Aimovig pen with a SingleCare coupon for Aimovig. Just know that you can’t use these coupons on top of Medicaid coverage.

Or, go straight to the source. Aimovig’s manufacturer (Amgen) offers a couple of assistance programs that can help make the drug’s price more manageable. The Amgen Safety Net Foundation provides free medications to patients who show financial need, and you may be eligible even if you have Medicaid.

If you’re struggling to pay for your migraine medications, don’t hesitate to talk to your healthcare provider. They often know ways to make medication more affordable and may even be able to recommend Aimovig alternatives.