Aimovig is one of those migraine-prevention meds that can feel like a small miracleright up until you see the price tag
and start doing mental math like you’re back in algebra class. The big question is simple: does Medicare cover Aimovig?
The honest answer is: sometimesbut it depends on which kind of Medicare coverage you have and
the specific plan’s drug list and rules.
This guide breaks down how Medicare coverage typically works for Aimovig, why two people with “Medicare” can have totally different
outcomes at the pharmacy counter, and what steps can improve your chances of getting it covered. We’ll keep it practical,
readable, and only mildly dramaticbecause the paperwork is dramatic enough.
Quick answer (for the “I have a headache right now” crowd)
- Original Medicare (Part A + Part B) usually won’t cover Aimovig at the pharmacy because it’s typically a self-administered injection used at home.
- Medicare Part D (a stand-alone drug plan) or a Medicare Advantage plan with drug coverage (MAPD) is where Aimovig coverage is most likely to show up.
- Even if it’s “covered,” you may still face restrictions (like prior authorization), specialty-tier cost sharing, and plan-specific rules.
Meet Aimovig (the medication, not the mythical creature)
Aimovig (erenumab-aooe) is a once-monthly injection used to help prevent migraines in adults. It works by targeting the CGRP pathway,
which plays a role in migraine attacks. Translation: it’s designed to lower the number of migraine days over time, not to treat a migraine that’s already in progress.
Most people take Aimovig at home using an auto-injector or prefilled syringe. That “take it at home” detail matters a lot for Medicare billing,
because Medicare splits drug coverage into different buckets depending on where and how a medication is given.
Which part of Medicare would cover Aimovig?
1) Medicare Part D (most common route)
Part D is Medicare’s outpatient prescription drug benefit. You can get it as:
(1) a stand-alone Part D plan paired with Original Medicare, or (2) built into many Medicare Advantage plans.
Part D plans use a formulary (a list of covered drugs) and can choose which specific medications they cover within categories.
Since Aimovig is generally a medication you pick up through a pharmacy (or specialty pharmacy) and inject yourself,
it typically falls under Part D coverage when it’s covered at all.
2) Medicare Part B (usually not, but there are edge cases)
Part B tends to cover drugs that aren’t usually self-administeredthink infusions or injections provided “incident to” a clinician’s service.
In plain English: Part B is more “given to you” than “picked up by you.”
Because Aimovig is designed for self-injection, it generally doesn’t fit the typical Part B profile. But Medicare coverage rules can get weird in real life.
In limited situationslike when a drug is administered in a clinical setting due to documented inability to self-injectcoverage questions can pop up.
If your provider is giving the injection in-office, your plan may need to decide whether it should be treated as a medical benefit (Part B style) or a pharmacy benefit (Part D style).
When in doubt, ask the plan specifically: “Is Aimovig covered under my Part D pharmacy benefit, and what are the requirements?”
Why Aimovig coverage varies so much from plan to plan
If Medicare were a single, unified program with a single drug list, life would be simple. Unfortunately (and very on brand),
Medicare drug coverage involves private plans with different formularies and different cost-sharing designs.
Two neighbors can live on the same street, have the same birthday month, and still have completely different Aimovig coverage.
Formulary status: covered vs. not covered
Every Part D/MAPD plan has its own formulary. If Aimovig isn’t on your plan’s formulary, the plan generally won’t pay for it
unless you get an approved exception.
Tier placement: “covered” doesn’t always mean “affordable”
Plans group drugs into tiers. Lower tiers usually have lower copays, and higher tiers (often “specialty” tiers) can involve higher coinsurance.
Many migraine biologics end up in higher tiers when they’re covered, which can lead to bigger out-of-pocket costsespecially early in the year.
Plan rules: prior authorization, step therapy, and quantity limits
Medicare drug plans can apply utilization management rules to decide how they cover a drug. The most common rules you’ll hear about are:
- Prior authorization (PA): The plan wants your prescriber to submit information proving the drug is medically necessary before coverage starts.
- Step therapy: You may need to try one or more other migraine preventives first before the plan will approve Aimovig.
- Quantity limits: The plan limits how much you can receive during a certain time period (for Aimovig, this often relates to monthly dosing limits).
These rules can feel like a pop quiz you didn’t study for. But they’re also a roadmap: if you know the rule, your prescriber can submit the right documentation
instead of playing fax-tag with the plan for three weeks.
How much does Aimovig cost with Medicare?
The frustratingbut truthfulanswer is: it depends. The amount you pay can vary based on:
your plan’s deductible, tier placement, coinsurance vs. copay structure, whether you use a preferred pharmacy, and how far you are in the year’s Part D cost-sharing stages.
Important 2026 cost protection: the Part D out-of-pocket cap
Here’s the good news: in 2026, Medicare Part D has an annual out-of-pocket cap of $2,100 for covered Part D drugs.
Once you reach that cap (based on how the program counts out-of-pocket spending), you shouldn’t pay copays/coinsurance for covered Part D drugs for the rest of the calendar year.
This is a major change from the old setup where people could keep paying a percentage indefinitely for high-cost meds.
In real life, this means Aimovigwhen coveredmight be expensive at the start of the year, but there is a ceiling on what you’ll pay out of pocket for covered Part D drugs in 2026.
(You still have to deal with the “is it covered” question first, of course. Medicare never gives you the gift without the riddle.)
Deductibles and specialty tiers: why January can feel extra rude
Many Part D plans have a deductible. If Aimovig is on a specialty tier with coinsurance, your share can be higher until you move through the plan’s cost-sharing phases.
That’s why some people see a big price in January, then a smaller price later, and then an even smaller price after reaching the annual cap.
Practical tip: if you’re comparing plans, focus on total annual cost (premium + estimated drug costs), not just the monthly premium.
A “cheap” plan can become expensive fast if it doesn’t cover Aimovig or places it on a high-cost tier.
How to check if your Medicare plan covers Aimovig
You don’t need a crystal balljust the right questions and the right places to look. Here’s a simple process:
Step 1: Check your plan’s formulary
- Search the plan’s online drug list for Aimovig (and confirm the strength/dose form).
- Note the tier and any restrictions (PA, step therapy, quantity limits).
- Look for “specialty pharmacy” requirements or preferred pharmacies.
Step 2: Call the plan and ask these five questions
- Is Aimovig on my formulary for 2026, and what tier is it?
- Do I need prior authorization?
- Is there step therapy (and if yes, what drugs count as the steps)?
- Are there quantity limits?
- What would my estimated cost be at my pharmacy, and does a specialty pharmacy change that cost?
If you can, write down the answers (and the date and the representative’s name). Not because you’re trying to start a true-crime podcast,
but because you’ll want consistency when your prescriber’s office asks what to submit.
Step 3: Coordinate with your prescriber on documentation
If your plan requires prior authorization or step therapy, ask your prescriber’s office to include the information plans commonly look for, such as:
diagnosis, migraine frequency, prior preventive medications tried (and why they didn’t work), and any contraindications.
This isn’t about “proving your pain” as much as it’s about matching the plan’s checklist so your request doesn’t get denied on a technicality.
What if Medicare denies Aimovig coverage?
A denial isn’t always the final wordit’s often the start of a process (annoying, yes, but still a process).
Under Part D, you can request a coverage determination and, when appropriate, an exception.
If you’re requesting an exception, your prescriber generally needs to provide a statement explaining the medical reason.
Common paths after a denial
- Formulary exception: If Aimovig isn’t on the drug list, you request the plan cover it anyway.
- Utilization management exception: If the plan requires PA/step therapy/quantity limits, you request a waiver based on medical need.
- Tiering exception: If Aimovig is covered but on a high-cost tier, you can sometimes request a lower tierthough specialty tier rules can limit this, depending on the plan’s structure.
- Appeal: If the plan denies your request, you can appeal through the plan’s appeals process.
Also consider timing: if you’re in the Medicare annual enrollment period (or another window where changes are allowed),
switching to a plan that covers Aimovig can be the cleanest solutionespecially if you expect to use it long-term.
Ways to save on Aimovig if you have Medicare
This is the part where many people hope for a magical co-pay card that drops the price to “two fancy coffees.”
For Medicare beneficiaries, the reality is more complicated.
1) Extra Help (the Part D Low-Income Subsidy)
If you have limited income and resources, Extra Help can reduce Part D premiums and lower drug costs.
Some people qualify automatically; others can apply. If cost is the main barrier, checking Extra Help eligibility is one of the highest-impact moves you can make.
2) Manufacturer programs: read the fine print
Aimovig has a co-pay card program for eligible people with commercial insurance, but it isn’t valid when the prescription is paid for in whole or in part by Medicare.
That’s common across many brand-name coupon programs, not just Aimovig.
That doesn’t mean “no assistance exists,” but it does mean you’ll want to look beyond typical co-pay cardssuch as independent patient assistance programs,
charitable foundations, or plan-based programsdepending on your situation. Always verify eligibility requirements before spending time on applications.
3) Use your plan’s preferred pharmacies and mail options
If your plan has preferred pharmacies or requires a specialty pharmacy, following those rules can materially change your cost.
Sometimes the “same” drug is priced differently depending on where you fill it.
If Aimovig isn’t covered: alternatives to discuss with your clinician
If your plan won’t cover Aimovig (or the cost is still too high), ask your clinician about other migraine-prevention options,
including other CGRP-targeting medications or different categories of preventives. Coverage can vary widely even within the same drug class,
so the “best covered” option may be different from the “most famous” one.
The goal isn’t to play medication roulette; it’s to find a treatment plan you can actually access consistently.
Preventive migraine care works best when it’s sustainablenot when you can only afford it for one dramatic month.
Conclusion: So… does Medicare cover Aimovig?
Medicare can cover Aimovig, but usually through Part D (or an Advantage plan with Part D) and only if your specific plan includes it on the formulary.
Even then, expect possible rules like prior authorization, step therapy, and specialty-tier cost sharing.
The best next step is practical: check your plan’s formulary, confirm restrictions, and work with your prescriber to submit the right documentation.
If you hit a denial, you may still have optionscoverage determinations, exceptions, appeals, or switching plans during an enrollment window.
And in 2026, remember one important guardrail: for covered Part D drugs, there’s an annual out-of-pocket cap, which can limit the year’s financial damage even for expensive medications.
Experiences people commonly have when trying to get Aimovig covered
Talking about “coverage” can feel abstract until you’re the one standing at the pharmacy counter hearing a sentence that begins with
“So, the system is saying…” Here are a few realistic, common experiences Medicare beneficiaries run into when Aimovig enters the conversation.
These aren’t medical advice or promisesjust the kinds of patterns people often describe when navigating plans, formularies, and paperwork.
Experience #1: “I have Medicare… why isn’t it covered?”
A very common moment happens when someone has Original Medicare (Part A and Part B) and assumes that includes prescriptions the same way
employer insurance did. They get the Aimovig prescription, go to fill it, and discover the uncomfortable truth:
Original Medicare alone doesn’t function as a pharmacy plan. The fix is usually adding a Part D plan (or enrolling in a Medicare Advantage plan with drug coverage).
It’s less “you did something wrong” and more “Medicare is a choose-your-own-adventure book written by committee.”
Experience #2: The prior authorization “paper chase”
Some people find Aimovig on the formularyvictory!but then the plan requires prior authorization. The first request might get denied because
a detail is missing: migraine frequency isn’t documented clearly, previous preventive meds aren’t listed, or the plan wants specific language
about why other treatments weren’t appropriate. The good news is that the second submission often goes smoother once the prescriber’s office knows
exactly what the plan wants. The not-so-good news is that the first round can feel like waiting for a package that’s stuck “out for delivery” forever.
Experience #3: Step therapy feels personal (but it’s mostly policy)
Step therapy can feel like a plan saying, “We don’t believe you,” when you’re really just trying to reduce migraine days enough to function normally.
But many plans are simply following their built-in rules: try one or more lower-cost preventives first, then move to Aimovig if those don’t work or aren’t tolerated.
People who have already tried other preventives sometimes do better here because their clinician can document the “steps” as already completed.
The key is detailed medication historydates, doses, outcomes, and side effectsbecause vague notes like “didn’t work” may not satisfy a plan reviewer.
Experience #4: Cost surprises early in the yearand relief later
Another common story is the “January shock.” A person gets approved, then the first fill is much more expensive than expected because the deductible resets
and the plan’s cost-sharing phases start over. Later in the year, the amount can drop, especially after reaching the annual Part D out-of-pocket cap for covered drugs.
People often describe this as emotionally exhausting: they feel hopeful because treatment is working, then anxious because the cost seems unpredictable.
What helps is planning aheadasking the plan for estimated costs by month, and setting expectations that the beginning of the year can be the toughest stretch.
Experience #5: The “plan switch that finally worked”
Some beneficiaries only get a workable outcome by switching plans during an enrollment period. They compare options, find a plan that lists Aimovig on its formulary,
confirm the restrictions, and choose the one with the best overall annual math. People who do this successfully often say the same thing afterward:
“I wish I’d checked the formulary before I enrolled last year.” It’s a very human lessonnobody wants to spend their fall reading drug lists,
but a little research can prevent a whole year of headaches (financial and literal).
The takeaway from these experiences is encouraging: coverage hassles are common, but they’re not always dead ends. With the right plan,
the right paperwork, and a bit of stubborn follow-through, many people do end up getting Aimovig coveredor find an alternative that fits both their health needs and their insurance reality.