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.