CurrentCignaPolicy IP0503

Migraine - Calcitonin Gene-Related Peptide Inhibitors - Aimovig

Defines Cigna's coverage, prior authorization requirements, and medical necessity criteria for Aimovig (erenumab) as preventive treatment of migraine in adults under Cigna-administered health plans.

Policy Summary

PayerCigna

PolicyMigraine - Calcitonin Gene-Related Peptide Inhibitors - Aimovig

Policy CodePolicy IP0503

Change TypeStep therapy relaxedauthorization duration increased

Effective Date

Next Review Date

Key ActionObtain prior authorization and document patient is ≥18 years old with ≥4 migraine headache days/month (approve for 1 year when criteria met).

SourceLink

POLICY UPDATE CHANGES

Removed requirement that patients must have tried Botox or at least two standard prophylactic pharmacologic therapies from different classes before Aimovig.

Initial authorization duration updated from 6 months to 1 year.

Updated coverage policy title to 'Migraine - Calcitonin Gene-Related Peptide Inhibitors - Aimovig'.

≥4migraine headache days/month required for approval

≥18minimum patient age for approval (years)

1 yearinitial authorization duration

Prior Authcoverage requirement

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Coverage and Medical Necessity Criteria

FDA-Approved Indication (Migraine Headache Prevention)

Approve for 1 year if the patient meets ALL of the following

Main criteria: A) Patient is ≥ 18 years of age; AND B) Patient has ≥ 4 migraine headache days per month (prior to initiating a migraine-preventive medication); AND C) If currently taking Aimovig, the patient has had a significant clinical benefit from the medication, as determined by the prescriber.

Examples of significant clinical benefit include a reduction in the overall number of migraine days per month or a reduction in number of severe migraine days per month from the time that Aimovig was initiated.

Aimovig (erenumab) is considered not medically necessary for the following uses: acute treatment of migraine; treatment or prevention of cluster headache; concurrent use with another injectable calcitonin gene-related peptide (CGRP) inhibitor prescribed for migraine prevention (examples include Ajovy, Emgality, Vyepti, and Qulipta when used as a preventive); concurrent use with Nurtec ODT (rimegepant) when Nurtec ODT is being used as a preventive therapy; and treatment or prevention of hemiplegic migraine. These indications are not supported by clinical trial data or were explicitly excluded from pivotal trials of Aimovig.

Use of Aimovig for any indication other than migraine headache prevention is considered not medically necessary. The policy lists specific conditions not covered — including acute migraine treatment, cluster headache, concurrent use with other CGRP inhibitors (injectable agents and certain oral agents when used preventively), and hemiplegic migraine — and notes this list may not be exhaustive and will be updated as new evidence becomes available.

Coding and Billing

No specific CPT/HCPCS/ICD-10 codes listed in documentmixed

No codes listed

Monthly migraine headache days

Threshold>= 4 migraine headache days per month (prior to initiating a migraine-preventive medication)

ContextRequired for initial approval under FDA‑approved indication for migraine headache prevention

Measurement periodBaseline monthly migraine days prior to initiating therapy

Prior Authorization, Documentation, and Billing Actions

Prior Authorization

Prior Authorization Required

Prior authorization is required for Aimovig. Approvals are issued for up to 1 year when initial or continuation criteria are met. Providers must submit documentation to support the patient’s age, baseline migraine frequency, and treatment response for continuations.

Prior authorization required — approve for 1 year when criteria met
Ensure claims use covered diagnosis/procedure codes

Documentation Required

Required Documentation

Documentation must be provided with the prior authorization request to support medical necessity. At a minimum, include: patient age; baseline migraine headache days per month (must be ≥ 4 prior to initiating a migraine-preventive medication); and for patients currently taking Aimovig, clinician documentation of significant clinical benefit (for example, reduction in overall migraine days per month or reduction in number of severe migraine days per month since initiation).

Background and Drug Information

Aimovig (erenumab) is a monoclonal antibody that targets the calcitonin gene-related peptide (CGRP) receptor and is indicated for preventive treatment of migraine in adults. Migraine is categorized clinically as chronic (headache on ≥ 15 days per month for > 3 months with migraine features on ≥ 8 days per month) or episodic (< 15 days per month), and preventive therapy is indicated for patients with frequent attacks, significant interference, or disability. Prior authorization is required for Aimovig, and approvals are granted when the coverage criteria for migraine prevention are met.

Clinical Definitions

Chronic migraine

DefinitionHeadache occurring on ≥ 15 days/month for > 3 months with migraine features on ≥ 8 days/month.

SourceInternational Headache Society definition as cited in policy disease overview

Clinical relevanceUsed to distinguish chronic from episodic migraine for treatment and coverage decisions

Episodic migraine

DefinitionHeadaches occurring on < 15 days/month.

ComparisonEpisodic migraine is more common than chronic migraine but associated with lower burden

Use in policy