CurrentCentenePolicy N/A

Erenumab-aooe (Aimovig) — Clinical Policy (coverage criteria)

Clinical policy governing medical necessity and coverage considerations for erenumab-aooe (Aimovig) and related CGRP inhibitors for migraine treatment under the Health Plan. Affects providers submitting authorization and coverage requests for these therapies.

Policy Summary

PayerCentene

PolicyErenumab-aooe (Aimovig) — Clinical Policy

Policy CodePolicy N/A

Change TypeConcurrent-use and coding updates

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and provide documentation of prior Botox response and ongoing migraine burden when requesting concurrent use or exceptions.

SourceLink

POLICY UPDATE CHANGES

Added Zavzpret to list of CGRP inhibitors that should not be prescribed concurrently with Aimovig and removed references to "injectable or oral CGRP" since Zavzpret is a nasal product.

Revised requirement on concurrent use with other CGRP inhibitors to include oral products with Nurtec and Ubrelvy listed as additional examples.

Clarified that concurrent prescribing with Botox or other CGRP inhibitors is restricted and added criteria for concurrent use with Botox requiring evidence of prior positive response and continued migraine burden.

4Q 2024most recent annual review referenced

11.24approval date for 4Q 2024 revisions

11.23approval date for 4Q 2023 annual review

02.21approval date for Feb 2021 revision

Coverage Criteria

Concurrent Use and Continued Therapy

Coverage of concurrent use with other CGRP inhibitors or Botox is subject to specified criteria.

Concurrent use with other CGRP inhibitors: Aimovig should not be prescribed concurrently with other CGRP inhibitors; the list of disallowed concurrent CGRP products has been updated to include Zavzpret and includes oral products such as Nurtec and Ubrelvy.

References to 'injectable or oral CGRP' were removed because Zavzpret is a nasal product; concurrent use exceptions require supportive evidence and prior authorization.

Concurrent use with Botox: Concurrent use of Aimovig with Botox is permitted only when supportive evidence is provided: citation from published studies or clinical practice guidelines, documentation of a prior positive response to Botox monotherapy, and continued migraine burden despite Botox treatment.

Added in 4Q 2022 annual review; documentation must justify concurrent therapy and will be evaluated during prior authorization.

Prescription of Aimovig (erenumab-aooe) should not be prescribed concurrently with other CGRP inhibitors unless the specific concurrent-use criteria in this policy are met. The list of CGRP agents for which concurrent prescribing is restricted has been updated over time to include oral agents such as Nurtec and Ubrelvy, and most recently the nasal product Zavzpret. Documentation supporting any exception to this restriction (for example, justification for concurrent therapy) must be provided with the authorization request.

Policy Summary

PayerCentene

PolicyErenumab-aooe (Aimovig) — Clinical Policy

Policy CodePolicy N/A

Change TypeConcurrent-use and coding updates

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and provide documentation of prior Botox response and ongoing migraine burden when requesting concurrent use or exceptions.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Actions & Requirements

Prior Authorization

Prior Authorization & Coding

Prior authorization is required for Aimovig. Use unclassified biologic/appropriate J-codes per payer billing guidance when applicable. Ensure prior authorization includes documentation of prior therapies and clinical rationale for current therapy.

Prior authorization required — include clinical documentation
Use appropriate HCPCS/J-codes per Centene billing guidance

Documentation Required

Botox Response Required for Concurrent Use

If concurrent use with onabotulinumtoxinA (Botox) is being requested, the prior authorization must include documentation of the patient’s prior response to Botox monotherapy and evidence of continued migraine burden despite Botox. Acceptable supportive evidence includes published studies or clinical practice guidelines supporting concurrent therapy, documentation of a positive clinical response to Botox alone (for example reduced headache days or improved functioning), and records showing persistent or recurrent migraine frequency/severity that justify adding Aimovig.

Document prior positive response to Botox monotherapy (e.g., headache day reduction, functional improvement)
Provide evidence of continued migraine burden despite Botox (e.g., headache diary, MIDAS/IMPACT scores, treatment dates and outcomes)
Include citations to published studies or practice guidelines when available

Documentation Required

Supportive Evidence for Concurrent Use

Supportive evidence must be submitted when concurrent use with Botox is requested. This includes prior treatment history showing benefit from Botox alone and current objective measures demonstrating ongoing migraine burden that warrants addition of Aimovig. Lack of documentation may result in denial or request for more information.

Submit treatment history with dates, doses, and objective response to Botox
Provide headache frequency/severity data after Botox treatment to demonstrate continued unmet need
Attach relevant literature or guideline excerpts if claiming benefit for concurrent therapy

Denial Risk

Concurrent CGRP Inhibitor Restrictions

Aimovig should not be prescribed concurrently with other CGRP-targeting therapies unless criteria for concurrent use are clearly met and documented. This restriction includes injectable, nasal, and oral CGRP inhibitors (examples: Emgality, Ajovy, Vyepti, Zavzpret, Nurtec, Ubrelvy). Requests for concurrent prescriptions must explicitly justify combined use and include prior authorization documentation as above.

Do not concurrently prescribe Aimovig with other CGRP inhibitors (e.g., Emgality, Ajovy, Vyepti, Zavzpret, Nurtec, Ubrelvy) unless documented criteria are met
If concurrent use is requested, submit justification and supportive evidence per prior authorization requirements

J3590	Unclassified biologics
C9399	Unclassified or biologicals drugs

OpenPayer

Erenumab-aooe (Aimovig) — Clinical Policy (coverage criteria)

Coverage Criteria

Coding

Provider Actions & Requirements

Background

Definitions / Billing Codes