Accessing CGRP blocking Migraine treatments can be a time-consuming, frustrating experience. My doctor and I first started discussing this option about six months ago. When we finally decided to give it a try, it took about three weeks to get an initial response from the company and another six weeks before I received my first dose. That’s when I discovered something very important. I couldn’t just sit around waiting for a phone call, a letter, or a delivery. If this was going to work, it would be my responsibility to make it happen.
Important strategies
Using these strategies helped me get long-term, affordable access to CGRP blocking Migraine treatments. Take a look. Maybe these ideas will work for you, too.
- Patience
We’ve all been waiting too many years for a better option. It’s difficult to contain our frustration and impatience. Yet that’s exactly what we must do. There are millions of people just like us who are trying to get access to these medications, too. It’s a long line full of frustrated, impatient, hurting people. A little patience, no matter how difficult to muster, can go a long way toward making the process easier for everyone. - Preparation
Expect delays and long wait times. When calling to check on the status of your approval or deliver, plan to wait on hold for up to 30 minutes. Set aside the time. Make the call when you can put your phone on speaker or wear headphones. You may be asked to fill out forms, applications, or provide documentation. Prepare yourself with the proper mindset, expecting that this will take work and time. - Planning
Instead of focusing on the outcome we desire, we can think about our options for each result. What if our phone call isn’t returned? What if the medication isn’t delivered as promised? What if our request or appeal is denied? Planning for all outcomes prevents us from giving up when things don’t happen the way we want. - Proactive action
Waiting for a phone call, email, letter, or delivery can be agonizing. When that promised response doesn’t happen, we can easily feel overwhelmed by our frustration. As difficult as it is, we’re ultimately responsible for taking care of these issues. If we’re owed a phone call or delivery that doesn’t come, it’s up to us to reach out. We must make the time to call to check on the status of our concern. We can track the progress by keeping notes all in one place. Write down every conversation, noting the date, time, name of the person, and the result of the call. Set reminders to follow-up, too. - Perseverance
When we feel frustrated, it’s okay to take a break or call a friend to blow off some steam. The important thing is that we return to the process. As exhausting as it is, no one else is going to do it for us. This is our health. We can’t afford to give up. - Politeness
The people who answer the phone and reply to our emails have a job to do. Showing them kindness can go a long way toward gaining their cooperation. No matter how difficult the process, it’s a good idea to thank them for their hard work.
Knowledge is power.
Take a look at all the access options for each of the new CGRP blocking Migraine treatments. Knowing our options gives us the power to make informed decisions. It also prepares us with realistic expectations. Both are necessary if we’re to form a winning game plan. Take a look at the many options available to help us gain access to these new treatments.
Free Trial Offer
With a valid prescription, patients can try 2 months of Aimovig™ at no cost to see if it’s right for us, regardless of insurance coverage. This offer expires 12/31/2018. Our doctors must submit a Service Request Form after we fill out and sign the first page. Call 833-AIMOVIG (833-246-6844) for more information.
Aimovig Ally™Access Card
The Amovig Ally™ program offers an Access Card to patients eligible for either the Copay Offer or Bridge to Commercial Coverage programs. This card can be presented at any participating pharmacy to redeem the offers.
Copay Offer
If you have commercial insurance that covers Aimovig™, we may be eligible for a $5 copay.
- Must have commercial insurance.
- Must be at least 18 years old.
- Must re-enroll every 12 months
- Maximum benefit is $2,700 per year.
Example:
→ Insurance agrees to cover 50% of the cost.
→ Before the Co-Pay Offer, our cost would be $287.50 ($3,450 per year).
→ With the Co-Pay Offer, our cost will be $5.
→ Amgen pays the $282.50 difference until it reaches $2700 (slightly more than 9 months).
→ Our total out-of-pocket expense for the year would be $750 ($3,450 – $2,700), or an average of $62.50 per month.
Bridge to Commercial Coverage
If our commercial insurance does not cover Aimovig™, we may still be eligible for up to 12 doses at no cost. Sample letters are available to help us and our doctor pursue insurance coverage during this program.
- Must have commercial insurance.
- Must not covered by any government-funded health care program (Medicare, Medicare Advantage, Medicare Part D, Medicaid, Medigap, VA, DOD, TRICARE, or where prohibited by law).
- Must be at least 18 years old.
- Must be a resident of US, Puerto Rico, or US territories.
- Must have a valid Aimovig™ prescription.
- Must have previously failed another migraine preventive.
- Must demonstrate efforts to pursue commercial coverage (Prior Authorizations, Formulary Exception Requests, Appeals, etc.).
Amgen Safety Net Foundation
This is a nonprofit organization that provides medications at no cost to patients who are uninsured, underinsured, and meet certain income and residency requirements. Aimovig™ is a covered medication under this program. To apply, complete the Aimovig Ally Service Request Form. It’s a good idea to keep a copy of the completed form for your records.
Requirements
- Must be a resident of the US or its territories for at least 6 months, 18 years or older.
- Must meet income eligibility requirements.
- Must be uninsured or insured by a plan that excludes Aimovig™.
- Medicare Part D patients may be eligible if they
→ demonstrate an inability to afford medication,
→ are ineligible for low-income subsidy,
→ satisfied all payer guidelines and Prior Authorization requirements prior to applying, and
→ have no other financial support options.
If approved…
- Patient must reapply each calendar year.
- Patient is required to request each month’s refill at least one week in advance.
- The medication is shipped via FedEx.
- Although not required by Amgen, FedEx usually requires someone be present to sign for and receive the shipment.
- It may be possible to pick up the package at a local FedEx store instead.
- The medication comes in an insulated styrofoam cooler, packed in ice and must be refrigerated immediately. If not refrigerated, it must be kept at room temperature and used within seven days.
- Plan to be home for delivery, make arrangements with a friend or neighbor, or contact your local FedEx office.
Ajovy Savings Card
Patients with commercial insurance may be eligible for $0 copay on Ajovy™ through 12/31/2019. Unlike the Aimovig Savings card, there’s no maximum annual benefit. It’s easy to download and print the copay card.
Requirements
This program is not available if you are uninsured or covered by:
- plans that cover 100% of prescription drug costs,
- some managed care plans,
- prescription discount cards,
- Medicare (Part D or employer-sponsored plan), or
- Medicaid, Medigap, DOD, VA, TRICARE, or other state or federally funded programs.
Shared Solutions
Teva has partnered with Shared Solutions to assist those not eligible for the Ajovy™ Savings Card.
- To apply for this program, call 800-887-8100 from 8:00 am to 8:00 pm central time. Be prepared to provide Ajovy™ prescription and insurance information during the call.
- Doctor and patient may also complete the Prescription & Service Request Form and fax it to 844-257-6127.
- Doctors may also submit the form electronically through IAssist.com.
- Remember to keep a copy for your records. It may be needed for follow up.
Teva Cares Foundation
At the moment, program details and eligibility criteria are not available for Ajovy™. However, it’s worth keeping an eye on this website. Amgen and Lilly already have programs, so it’s likely that Teva will, too.
Emgality™ Copay Program
Patients with commercial insurance may be eligible for 12 months of Emgality™ at no cost, even if insurance denies coverage. To apply, text “INFO” TO 54552 and follow the link request to the electronic application or apply online.
Requirements
- Sign HIPAA authorization for Lilly to work on your behalf.
- Benefits last 12 months.
- Expires 12/31/2020.
- Available to patients 18 years and older.
- Doctor must submit prior authorization or formulary exception request to our insurance provider. Sample letters are available at the Emgality™ Health Care Provider portal.
- The annual maximum is $4,900.
- Only available to patients with commercial insurance.
- Not available to uninsured, Medicare Part D, Medicaid, Medigap, DOD, VA, TRICARE/CHAMPUS, in connection with other pharmaceutical assistance, or in Massachusetts.
- Available only in the US and Puerto Rico to legal residents.
Lilly Cares Foundation
While Emgality™ is not yet listed as a covered medication, it is expected to be covered by mid-October. Patients who meet the criteria and are uninsured or have Medicare Part D may be eligible. Lilly Cares offers medications at no cost to patients who meet residency, insurance, and income requirements. For more information, call 800-545-6962 Monday through Friday from 8:00 am to 5:00 pm eastern time. When Emgality™ is available, online applications will be accepted, too.
Program Qualifications
- Must have a valid prescription.
- Must be a permanent legal resident of the US or Puerto Rico.
- Meet the annual income limit for Group A products.
- Must provide proof of income.
- Must not be enrolled in Medicaid or VA benefits.
- Must be uninsured or enrolled in Medicare Part D*, if eligible.
- Medicare Part D patients must meet a $1,100 out-of-pocket pharmacy minimum prior to receiving benefits through this program. This minimum includes all out-of-pocket pharmacy expenses, not just Lilly branded medications.
- Provides up to a 1-year supply, shipped in 4-month supplies.
But wait, there’s more!
Patients not eligible for any of these programs may still qualify for other programs. Check out the Partnership for Prescription Assistance (PPARx). PPARx does not directly provide free or reduced cost medication. Instead, they’re a clearinghouse for many different assistance programs. They connect patients in need with resources that may be able to help. Call them at 888-477-2669 or visit their website at www.pparx.org.
Resource Summary
- Aimovig Ally™ Program
- Aimovig™ Access Card
- Service Request Form
- Prior Authorization and Formulary Exception sample letters
- Amgen Safety Net Foundation
- Ajovy™ Savings Card download
- Shared Solutions
- Prescription & Service Request Form
- IAssist.com – physician portal
- Emgality™ Copay Program
- Online Application
- Health Care Provider Portal
- Lilly Cares Foundation
- Income Criteria
- Acceptable Proof of Income documents
Special thanks
Many thanks to Shoshana Lipson from the CGRP & Migraine: Aimovig, Ajovy, Emgality & more Facebook group for her valuable contributions to this guide.