CurrentCignaPolicy N/A

Aimovig (erenumab-aooe) — Drug Quantity Management (Coverage Criteria)

Defines quantity limits and override criteria for Aimovig (erenumab-aooe) prefilled autoinjectors/syringes for Cigna-administered health benefit plans; applies to providers submitting coverage requests and pharmacy dispensing. Affects members whose plans follow Cigna coverage policies.

Policy Summary

PayerCigna

PolicyAimovig (erenumab-aooe) — Drug Quantity Management (Coverage Criteria)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionIf quantity limits are exceeded, request a one-time override for a single 70 mg unit only for titration to 140 mg; otherwise adhere to stated quantity limits.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

1/30dRetail max (70/140 mg)

3/90dHome delivery max (70/140 mg)

one-timeTitration override

none140 mg overrides

migraineIndication

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Coverage & Drug Quantity Management Criteria

Drug Quantity Management criteria

Covered when the Drug Quantity Management rules and the following specific criteria are met:

Dose and quantity management: For Aimovig 70 mg/mL: retail maximum 1 auto-injector per 30 days; home delivery maximum 3 auto-injectors per 90 days. For Aimovig 140 mg/mL: retail maximum 1 auto-injector per 30 days; home delivery maximum 3 auto-injectors per 90 days.see thresholds

Derived from Drug Quantity Limits section

Titration override: If the patient requires dose titration from 70 mg once monthly to 140 mg once monthly, approve a one-time override for one 70 mg/mL prefilled syringe or auto-injector at retail or home delivery.one-time override for one 70 mg unit

Use 140 mg auto-injector in other situations when changing to 140 mg dose

No overrides for 140 mg: No overrides recommended for Aimovig 140 mg/mL prefilled auto-injector/syringes.no overrides

Explicit policy statement

Coverage for Aimovig is governed by the Drug Quantity Management limits specified in this policy. Any request that exceeds the stated retail or home-delivery quantity limits and does not meet the policy’s override criteria is considered not medically necessary and will not be approved.

Exceptions to the Drug Quantity Management rules will only be considered when they meet the explicit override criteria described in the policy. Any exception that does not satisfy the stated override condition (for example, the one-time 70 mg titration allowance) is considered not medically necessary and should not be approved.

Provider Requirements, Prior Authorization, and Denials

Denial Risk

Denial Triggers

Claims submitted without appropriate covered diagnosis or procedure codes as defined by the applicable benefit plan and this policy will be denied. Providers must bill using the most appropriate and current codes as of the date of submission. Claims missing required supporting documentation (including clinical rationale for dose escalation or step therapy failures) or submitted for quantities that exceed the Drug Quantity Management limits will be denied as not covered.

Use most appropriate codes as of date of submission
Claims without covered codes will be denied
Required supporting documentation must accompany requests

Step Therapy

Step Therapy / Drug Quantity Management Overview

This policy is a Drug Quantity Management program that manages dose escalation for Aimovig. At point of service, the Drug Quantity Management rule is applied; if the requested quantity does not meet the rule, coverage will be determined by the criteria in this policy. Approvals, including any one-time overrides for dose titration, are issued for the duration specified in the Criteria.

Program manages dose escalation for Aimovig
Point-of-service quantity rule applies; failure to meet it triggers criteria review
Approvals provided for the duration stated in the Criteria

Documentation Required

Required Documentation and Override Process

Providers requesting prior authorization or override for dose titration must submit documentation that supports the medical necessity of the requested quantity, including prior dosing regimen, clinical rationale for titration, and any relevant prior therapy trial/failure information as required by the benefit plan. For Aimovig 70 mg → 140 mg titration, request a one-time override with supporting documentation per the criteria. Requests that do not include required documentation or applicable codes will be denied.

Submit prior dosing and clinical rationale for dose escalation
Include documentation of prior therapy trials/failures if applicable
One-time override allowed for 70 mg → 140 mg titration per criteria; no overrides recommended for 140 mg product

Initial Therapy Guidance

Initial therapy guidance

Dosing and supply limits for initiation and dispensing

Standard dosing: Recommended starting dose is 70 mg subcutaneously once monthly; some patients may benefit from 140 mg subcutaneously once monthly.70 mg monthly; 140 mg optional

From prescribing information

Product availability: Available as 70 mg/mL and 140 mg/mL single-dose prefilled autoinjectors; prefilled syringes are approved but currently not available.N/A

Supply note

Override Description	Allowed Quantity	Setting	Coverage
One-time titration override from 70 mg once monthly to 140 mg once monthly (for initiation of the higher dose)	One 70 mg/mL prefilled syringe or auto-injector	Retail or home delivery	Covered (one-time override)

Quantity Limits by Strength & Dispensing Channel

Aimovig 70 mg/mL auto-injector — retail

Retail quantity limit1 auto-injector per 30 days

Home delivery equivalentN/A — see home delivery block for 90‑day supply

Unit size1 mL per auto-injector (70 mg/mL)

Aimovig 70 mg/mL auto-injector — home delivery

Home delivery quantity limit3 auto-injectors per 90 days

Equivalent monthly supplyUp to 3 months (one auto-injector per month)

Unit size1 mL per auto-injector (70 mg/mL)

Aimovig 140 mg/mL auto-injector — retail

Retail quantity limit1 auto-injector per 30 days

Unit size1 mL per auto-injector (140 mg/mL)

Home delivery equivalentSee home delivery block for 90‑day supply

Aimovig 140 mg/mL auto-injector — home delivery

Home delivery quantity limit3 auto-injectors per 90 days

Equivalent monthly supplyUp to 3 months (one auto-injector per month)

Unit size1 mL per auto-injector (140 mg/mL)

Dispensing Site Rules

Billing Rule

Retail vs home delivery quantity limits

Retail dispensing is limited to 1 auto-injector per 30 days; home delivery may be supplied up to 3 auto-injectors per 90 days.

Retail maximum quantity per 30 days = 1 auto-injector (1 mL) for both 70 mg and 140 mg strengths.
Home delivery maximum quantity per 90 days = 3 auto-injectors (3 mL) for both 70 mg and 140 mg strengths.