{"id":6895,"date":"2025-02-03T11:24:30","date_gmt":"2025-02-03T11:24:30","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicare-cover-aimovig-in-2025\/"},"modified":"2025-02-03T11:24:30","modified_gmt":"2025-02-03T11:24:30","slug":"hmn-does-medicare-cover-aimovig-in-2025","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-does-medicare-cover-aimovig-in-2025\/","title":{"rendered":"HMN: Does Medicare cover Aimovig? in 2025"},"content":{"rendered":"<p>\n<br \/>Do you know:  Does Medicare cover Aimovig? in 2025<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">Aimovig is an injectable biologic drug from the class of CGRP antagonists that\u2019s prescribed to prevent migraine.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Many Medicare Part D plans will cover Aimovig, and the drug\u2019s website says just over two-thirds of Medicare beneficiaries who receive coverage will pay $20 or less per month.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">Aside from Medicare, there are several ways to lower your out-of-pocket cost for Aimovig, such as using a  discount card or applying for financial assistance programs.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<section class=\"table-of-contents\">\n<div class=\"anchorLinks\">\n<div class=\"mobile-only\">\n<div class=\"dropdownLists\">\n<div class=\"dropdownBtn\"><span class=\"listsIcon\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/union.svg\" width=\"14\" height=\"20\"\/><\/span><br \/>\n\t\t\t\t\t\t\t<label><\/label><br \/>\n\t\t\t\t\t\t\t<span class=\"downArrow\"><br \/>\n\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/themes\/singlecare\/images\/dropDownArrow.svg\" width=\"24\" height=\"24\"\/><br \/>\n\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/p><\/div>\n<\/section>\n<p><span style=\"font-weight: 400;\">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, <\/span><span style=\"font-weight: 400;\">Aimovig<\/span><span style=\"font-weight: 400;\"> (erenumab-aooe) can be a big help. This brand-name once-monthly injectable biologic medication targets a migraine catalyst called <\/span><a href=\"https:\/\/headaches.org\/cgrp-need-know\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">calcitonin gene-related peptide (CGRP)<\/span><\/a><span style=\"font-weight: 400;\"> to help prevent future attacks. Aimovig\u2019s 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.\u00a0<\/span><\/p>\n<h2 id=\"how-much-does-aimovig-cost\"><span style=\"font-weight: 400;\">How much does Aimovig cost?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">For anyone paying completely out of pocket\u2014without insurance coverage or help from Medicare\u2014Aimovig costs an average of $1,064 per 140 mg\/mL autoinjector. It\u2019s a once-monthly injection, so that means a year\u2019s worth of Aimovig treatment would cost over $12,000. There\u2019s no <\/span><a href=\"https:\/\/www.cancer.org\/cancer\/managing-cancer\/treatment-types\/biosimilar-drugs\/what-are-biosimilars.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">biosimilar alternative<\/span><\/a><span style=\"font-weight: 400;\">\u2014which are often less expensive. \u201cWith a patent that will not expire until 2031 at the earliest (patent extensions are common), the cost is unlikely to decrease anytime soon,\u201d says <\/span><a href=\"https:\/\/www.medicareresources.org\/authors\/tanya-feke-m-d\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Tanya Feke, MD<\/span><\/a><span style=\"font-weight: 400;\">, a health policy analyst.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Yet that price isn\u2019t set in stone. Insurance coverage and financial assistance programs are available. And retail prices can vary greatly by pharmacy. The <\/span><a href=\"https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/0a464f25f0f2e987170f0a1d7ec21448\/RRA328-1-Rxsupplychain.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pharmaceutical supply chain<\/span><\/a><span style=\"font-weight: 400;\"> is a complex structure that involves not just pharmacies but manufacturers, wholesalers, pharmacy benefit managers, and insurance companies.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">While pharmaceutical companies set prices for their drugs, negotiations happen at almost every level, which is why \u201cprices can vary depending on the pharmacy. Some pharmacies may have negotiated better prices with suppliers, leading to lower costs for consumers,\u201d according to <\/span><a href=\"https:\/\/www.linkedin.com\/in\/doshiojas96\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Ojas Doshi<\/span><\/a><span style=\"font-weight: 400;\">, a product development scientist in the pharmaceutical industry. Sometimes, prices between pharmacies can vary by <\/span><a href=\"https:\/\/publicinterestnetwork.org\/wp-content\/uploads\/2022\/07\/WEB_USP_Real-Price-Medications_030519-1.pdf\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">hundreds of dollars<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2 id=\"does-medicare-cover-aimovig\"><span style=\"font-weight: 400;\">Does Medicare cover Aimovig?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In many cases, yes, Medicare will cover Aimovig. But only under certain Part D or Medicare Advantage plans. \u201cSince Aimovig is an injectable drug typically administered at home, it would likely be covered under Part D plans,\u201d Doshi says. Medicare Part D includes standalone prescription drug plans that Medicare beneficiaries can add to their existing Part A or Part B coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Original Medicare (Parts A and B) <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/medicare-basics\/parts-of-medicare\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">doesn\u2019t cover a wide range of outpatient prescription drugs<\/span><\/a><span style=\"font-weight: 400;\">, but \u201cif Aimovig is administered in a doctor\u2019s office rather than at home, it could be covered under Medicare Part B, which handles outpatient services,\u201d Doshi says. \u201cHowever, this is less common for Aimovig, as it is primarily designed for self-administration.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Some Part D or Medicare Advantage plans, however, may need <\/span><span style=\"font-weight: 400;\">prior authorization<\/span><span style=\"font-weight: 400;\"> 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:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Confirmation that the headaches are, in fact, migraine and not another kind of headache, like a tension headache<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">The frequency of headaches<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Documentation that shows what medications patients have tried before, how long they tried them, and how effective they were<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Essentially, the healthcare provider may have to prove Aimovig is medically necessary.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cThey may also require patients to try other, cheaper drugs before they can get them on Aimovig,\u201d says Michael O. McKinney, MD, primary physician at <\/span><a href=\"https:\/\/www.healthyoutlookjax.com\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Healthy Outlook<\/span><\/a><span style=\"font-weight: 400;\">. This is called <\/span><span style=\"font-weight: 400;\">step therapy<\/span><span style=\"font-weight: 400;\">. After reviewing these documents and attempts, Medicare will determine whether it will cover the Aimovig prescription.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Plus, keep in mind that <\/span><a href=\"https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-novel-preventive-treatment-migraine\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">the Food and Drug Administration (FDA) has only approved Aimovig<\/span><\/a><span style=\"font-weight: 400;\"> for the prevention of migraine, but some doctors may prescribe it off-label for cluster headaches or vestibular migraine. Since the FDA hasn\u2019t officially approved it for those conditions, some plans may refuse to cover these cases.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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 <\/span><a href=\"https:\/\/www.patientadvocate.org\/explore-our-resources\/understanding-health-insurance\/understanding-drug-tiers\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">organize covered drugs into tiers<\/span><\/a><span style=\"font-weight: 400;\">, with generics in the lowest tier and more specialty or brand-name drugs in the higher ones. The lower the tier, the less you\u2019ll typically pay.<\/span><\/p>\n<h3 id=\"how-much-does-aimovig-cost-on-medicare\"><span style=\"font-weight: 400;\">How much does Aimovig cost on Medicare?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">This can also vary significantly based on your Medicare plan, your condition, and several other factors. <\/span><a href=\"https:\/\/www.aimovig.com\/paying-for-aimovig\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">The manufacturer of Aimovig<\/span><\/a><span style=\"font-weight: 400;\">, 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\u2019t, they won\u2019t apply.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Many times, expenses depend on how a specific Medicare plan classifies Aimovig. \u201cTier placement can affect patients\u2019 out-of-pocket costs,\u201d Dr. McKinney says. \u201cOften, there are high copays or coinsurance when Aimovig appears in a higher-tier category.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Other factors influencing how much you pay include what phase of Part D coverage you are in\u2014whether it\u2019s the deductible phase, initial coverage phase, coverage gap (donut hole), or catastrophic phase.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">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\u2019s Low-Income Subsidy, known as Extra Help, will also pay less.<\/span><\/p>\n<h2 id=\"how-to-save-on-aimovig\"><span style=\"font-weight: 400;\">How to save on Aimovig<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Even without Medicare coverage, it\u2019s possible to bring down AImovig\u2019s out-of-pocket costs\u2014sometimes pretty significantly. Here are a few of the most common <\/span><span style=\"font-weight: 400;\">ways to save on Aimovig<\/span><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li aria-level=\"1\"><b>Use a  discount card. <\/b><span style=\"font-weight: 400;\">The free discounts from  can take around $300 off the price of your Aimovig prescription, depending on your pharmacy and geographic location. Anyone can <\/span><span style=\"font-weight: 400;\">sign up for <\/span><span style=\"font-weight: 400;\">, even if you have Medicare Part D. Just know you can\u2019t stack  discounts on top of Medicare coverage. You\u2019ll have to choose one or the other.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>Get help from the Amgen Safety Net Foundation. <\/b><span style=\"font-weight: 400;\">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\u2019t afford the out-of-pocket costs\u2014as long as you meet certain income requirements. Check your eligibility on the <\/span><a href=\"https:\/\/www.amgensafetynetfoundation.com\/eligibility.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Amgen Safety Net Foundation website<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>Ask about alternatives.<\/b><span style=\"font-weight: 400;\"> Direct alternatives to Aimovig\u2014other CGRP antagonists like <\/span><span style=\"font-weight: 400;\">Emgality<\/span><span style=\"font-weight: 400;\"> and <\/span><span style=\"font-weight: 400;\">Ajovy<\/span><span style=\"font-weight: 400;\">\u2014might come at a similar price. But insurance and Medicare plans may be more open to covering one over the other. Additionally, CGRP antagonists aren\u2019t the only way to prevent migraine, and your healthcare provider might have <\/span><span style=\"font-weight: 400;\">recommendations for other, less expensive options<\/span><span style=\"font-weight: 400;\">. However, other medications might help treat migraine symptoms after they begin rather than prevent them, as Aimovig does.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>Consider private health insurance. <\/b><span style=\"font-weight: 400;\">Commercial insurance plans won\u2019t 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.<\/span><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><b>Apply for Medicaid or Medicare Extra Help. <\/b><span style=\"font-weight: 400;\">Medicaid is a joint federal and state program that provides additional support for Medicare beneficiaries who need it. <\/span><a href=\"https:\/\/www.medicaid.gov\/medicaid\/eligibility\/index.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Eligibility requirements<\/span><\/a><span style=\"font-weight: 400;\"> vary by state, so check your state\u2019s enrollment procedures to learn how to apply. Medicare also has a program called <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/a><span style=\"font-weight: 400;\">, 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.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Medicare coverage varies by plan, but most Part D plans cover Aimovig<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 25.1413 9.27138 25.45 8.3206C24.6436 8.80066 23.7608 9.1389 22.84 9.3206C22.2245 8.65317 21.405 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Many Medicare Part D plans will cover Aimovig, and the drug\u2019s website says just over two-thirds of Medicare beneficiaries who receive coverage will pay $20 or less [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6895","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/6895","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=6895"}],"version-history":[{"count":0,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/6895\/revisions"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=6895"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=6895"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=6895"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}