Aimovig, Medicaid, Medicare and the Uninsured

By now you’ve heard about the newest and first medication specifically to prevent migraine.  Aimovig™ was approved by the United States Food and Drug Administration (FDA) on May 17, 2018. As written on their website, Aimovig is “the first and only FDA-approved therapy specifically designed to help prevent migraine in adults by targeting and blocking the calcitonin gene-related peptide receptor (CGRP-R).^”  In this article you will learn what you, as a person with migraine, or your caregiver will need to do to apply for the Aimovig™ monthly injection and get your first two doses FREE if you do not have insurance or have a government sponsored health plan, like Medicaid.

Disclaimer: I am a former Amgen and Novartis Spokesperson. This content reflects my own personal opinions and was not created or reviewed by Amgen and Novartis. I was not paid to write this article.

What is the Amgen Safety Net Foundation

The Amgen Safety Net Foundation website states it “does not charge patients a fee for its assistance. Amgen Safety Net Foundation is not affiliated with third parties who charge a fee for assistance with enrollment or medication refills. If you are being charged a monthly fee for support from the Amgen Safety Net Foundation, the organization billing you is not the Amgen Safety Net Foundation and you are being charged for support that the Amgen Safety Net Foundation can provide to you directly at no cost.”

In my opinion, this is an amazing organization sponsored by a pharmaceutical company, especially for those who cannot afford life-saving medication. As a person with migraine, I am very grateful towards Amgen for allowing Aimovig™ to participate in this program. Kuddos!!! I have not yet received my first dose as of the date of this post, but I will update soon about my experience with the application process.

Eligibility Requirements

It is possible you may qualify for the “at no cost from Amgen Safety Net Foundation” if you meet certain requirements, according to the Aimovig™ Service Request Form and Prescriptions (Download) form you can fill out and take to your doctor.

I have Medicaid and considered low-income. Everyone’s reasons are their own and I’m not one to judge because I completely understand!! Chronic medical issues wreak havoc on our income avenues and if you rely on each paycheck, life gets difficult really fast. My hope is that if you are struggling financially and meet the following eligibility requirements, you might be able to receive Aimovig™ free for 12 months:

• Resident of the United States or its territories
• Those in one of the following insurance situations:
  • Uninsured
  • Patient’s Insurance Plan excludes the Amgen product
• Patient demonstrates a financial need: Income at or below 500% of the federal poverty limit (FPL) as shown below

• Certain standard Medicare Part D patients with product coverage that cannot afford their out-of-pocket costs may be eligible. These patients must:
  • Meet additional financial criteria demonstrating their inability to afford the product
  • Not be eligible for Medicaid or Medicare’s low-income subsidy (LIS)
  • Satisfy all payer guidelines and prior authorization (PA) requirements prior to
  • applying for assistance
  • Not have any other financial support options

On the form, you will see the above requirements listed under Section 3: Optional Amgen Safety Net Foundation on Page 1. The steps to fill out this portion will be described later in this article.

The form itself is pretty self-explanatory, but it’s very wordy. If you have migraine, those words will start to run into each other at some point and might break your brain! Ha! I admit, I did have to take a couple breaks when filling it out because I had the smart idea of working on it during a mild migraine attack. Here’s some advice, wait until your brain works to do this. That’s just an all-around, smart idea. Better yet, have someone help you and review it before you take the form to your doctor’s office.

By filling out the form yourself and checking the right boxes, your doctor will appreciate your efforts AND can cut down on errors in processing. It’s also important to note that you do need the appropriate diagnosis codes from your doctor when he submits the form. I cannot give you that code, but if your doctor is unsure, urge his office to contact Aimovig Ally™ for clarification. You can also contact the Aimovig Ally™ program yourself if you have any questions. When I called, the customer service representative was very knowledgeable and helpful. You can reach them at 833-AIMOVIG (833-246-6844), Monday–Friday, 8 am–8 pm ET.

How to Fill Out the Aimovig Ally™ Service Request Form and Prescriptions Form

A customer service representative with Aimovig Ally™ helped me fill out my form. I am going to go over what we discussed and hopefully this will help you have a smooth experience with this form. Some people were not as lucky.

Section 1: Patient Information

At the top of the form you will find Section 1 for Patient Information input. Section 1 is pretty self-explanatory. I will not go over this area in detail, just be sure you are okay with Amgen leaving a detailed message on your phone if you check the Cell Phone or Home Phone boxes.

Section 2: Prescription Insurance Information

Section 2, Prescription Insurance Information, is where I had questions for Customer Service. Since I am a North Carolina Medicaid recipient, I was unsure if I needed to put information here. I’m glad I called because I did. I also had to make copies of the front and back of my card to attach to the form. DO NOT FORGET to do this. Without a copy of your Medicaid card, your application could be denied.

Here’s what I filled-out to complete my form:

1. Beneficiary/Cardholder Name: I typed in my full name as it appears on my Medicaid card.
2. ID #: Type the full Identification Number as it appears on your card. If you cannot find one, please contact your Medicaid case worker to ask for it.
3. Prescription Insurance/Primary Insurance: Type the full name of your Medicaid coverage. For example, I have North Carolina Medicaid, but there are several “sub-types” that look like separate companies. I typed both “North Carolina Medicaid” and the name of the plan on this line.
4. Phone #: Usually a toll-free number
5. Rx Group#: I left blank
6. Rx BIN #: I left blank
7. Rx PCN#: I left blank
8. Secondary Insurance & related spaces: I only have Medicaid, so I left this space blank. If you have secondary insurance, please fill out the next few lines appropriately. Contact customer service if you have questions.
9. Sharps Disposal Container: Check this box. This container will keep you and your family safe from accidental injury from the needles.
10. Aimovig™ Copay Program: I did not check the last box, as I do not have commercial insurance.

NOTE: Don’t forget to sign the Patient Authorization under Sections 1 & 2.

Section 3: Amgen Safety Net Foundation (Optional but FILL IT OUT)

Below you will find the eligibility requirements and the application for the Amgen Safety Net Foundation. This is the portion you will fill out if you feel you meet any of the eligibility requirements listed. When I filled out this portion, I knew I made less than 500% of the federal poverty limit for four people, which is $125,500. These rates are very generous. I am very appreciative of Amgen for their Safety Net program. You can find additional rates listed in the graphic above titled “Household Income Guidelines” or on the website at http://www.amgensafetynetfoundation.com/eligibility.html.

Let’s go over boxes 1 through 10! Don’t forget to sign and date before giving to your doctor. Please read very carefully the left-hand column for all eligibility requirements. If you do not understand something, please call the Aimovig Ally™ customer support line.

1. Box 1: I have lived in the US for more than 6 months, I checked Yes
2. Box 2: I have lived in North Carolina for more than 6 months, I checked Yes
3. Box 3: Add the total amount of income you have. My husband has VA disability, I added this income. Please be as truthful as possible, you may have to provide proof of income, such as a past Income Tax Return.
4. Box 4: List all persons living at your current address, even if they are not your children or spouse. Keep in mind your tax return may be used as proof.
5. Box 5: I checked Yes, as I am a US Citizen.
6. Box 6: I checked No, as I do have Medicaid. Uninsured means you have no insurance coverage, not even government healthcare, like Medicare or Medicaid.
7. Box 7: I checked Yes, as Medicaid is not currently covering Aimovig™ at this time according to the Aimovig Ally™ customer service rep. This information will be updated as soon as it is approved, which may be up to each individual state.
8. Box 8: I checked No, I do not have Medicare. If you have Medicare Part D, please check this box if you CANNOT afford your cost share. There is a sub-question to Box 8. Please check the appropriate box for your situation.
9. Box 9: I checked Yes. I do have North Carolina Medicaid. I checked No to the Emergency Medicaid sub-question, as I do not have Emergency Medicaid. If you are unsure if you have Emergency Medicaid, please contact your Medicaid case worker for clarification. If you were denied Medicaid, please check No.
10. Box 10: I checked No since I do have Medicaid. If you have applied and were denied, please check Yes.

Section 6: Aimovig™ Free Trial Offer Rx (Optional but FILL IT OUT)

Aimovig™ is giving patients with a doctor’s prescription a FREE two-month trial. How amazing is that??!! Impressive is what it is. Even if you do not have insurance, do not meet the eligibility requirements of the Amgen Safety Net Program you can still receive a free two-month supply of Aimovig™, but only with a doctor’s prescription. Here’s what you need to try Aimovig™ with or without insurance:

1. Check the “Free trial only” box so your doctor will know to fill out this section
2. Leave the rest of the boxes empty. Your doctor will fill out the rest. Make sure you mark and “x” or place a “sign-here” note next to this section so your doctor won’t miss it!

Section 7: Aimovig™ Bridge to Commercial Coverage Rx

This section is not for people with Medicaid or Medicare. It is also not for people with no insurance coverage. The Bridge to Commercial Coverage Rx is for people with migraine who have commercial insurance and are waiting for their insurance company to cover Aimovig™. It is a great program and can provide Aimovig™ FREE for up to 12-months while you’re waiting for coverage. Your doctor must fill this out.

Submitting to Your Doctor

Here is a checklist to help you get things in order before sending to your doctor:

• Add Sticky Notes. Once you have completely filled out the form for your doctor, I highly suggest adding sticky notes to the sections you completed.
• Highlight Doctor Responses. With a highlighter or sticky note, highlight the areas where your doctor needs to sign. These areas are all on Page 2 of the form.
• IMPORTANT – Attach a copy of your Medicaid or Medicare card. Make a copy of the front and back of your Medicaid or Medicare card. Make sure you provide this with the form to your doctor. If your coverage card is not provided, you run the risk of being denied.
• Contact Aimovig Ally™ for Questions. The contact information to the Aimovig Ally™ program are provided on the website. I have also included the info here:

Good Luck!

Well, that’s pretty much it. If I missed a step or you have updated information about this form, PLEASE let me know in the comments. Remember, these instructions are based off my experience with the form, my doctor’s office, and the Aimovig Ally™ customer service representative. The above advice is based on my personal experience and is not in place of an Aimovig Ally™ customer service representative’s information. If ever in doubt, please contact them to complete your form. They are happy to help!

Useful Aimovig™ and Amgen Links

• FDA Approval Announcement
• Aimovig™ Ally™
• Amgen Safety Net Foundation
• Aimovig™ Service Request Form and Prescriptions [DOWNLOAD]

Other Articles by Achy Smile Discussing Aimovig™:

• Aimovig Updates (Month 1)
• Aimovig Updates (Month 2)
• Aimovig Updates (Month 3)
• Writing a Letter to My Inconsistent Brain
• Mental Slump = Physical Exhaustion

---

Disclaimer: I am a former Amgen and Novartis Spokesperson. This content reflects my own personal opinions and was not created or reviewed by Amgen and Novartis. I was not paid to write this article.