Aimovig denied by insurance? Appeal and win.
A denial of Aimovig is rarely the end of the road. It is usually the start of a documentation process, because most plans place this drug behind step therapy and prior authorization rather than excluding it outright. Aimovig denials are frequently overturned when the appeal clearly shows the migraine diagnosis, the older preventive medicines that were already tried and failed, and how the patient meets the plan's own coverage criteria.
Reviewed by the Apellica Appeals Team · Updated June 2026
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Aimovig (erenumab) is FDA approved for the preventive treatment of migraine in adults.
Why Aimovig gets denied
- Step therapy not satisfied: the plan requires documented trial and failure (or intolerance or contraindication) of two or more older preventive classes, such as beta-blockers, tricyclic antidepressants, or anticonvulsants like topiramate or valproate, before it will cover a CGRP agent.
- Prior authorization criteria not documented: the migraine frequency (episodic 4 or more migraine days per month, or chronic 15 or more headache days per month) is not clearly recorded in the chart, so the reviewer cannot confirm the patient meets the definition.
- Non-formulary or non-preferred status: the plan prefers a different CGRP product (for example Ajovy, Emgality, Qulipta, or Nurtec ODT) and requires a formulary or tier exception before approving Aimovig.
- Continuation denial: at reauthorization the plan asks for evidence of response, typically at least a 50 percent reduction in monthly migraine days or a documented meaningful decrease, and that response data was not submitted.
What a winning appeal includes
- A clear diagnosis with the correct ICD-10 code (for example G43.709 for chronic migraine without aura, not intractable, without status migrainosus, or G43.009 for migraine without aura), plus a headache diary or chart note documenting baseline migraine and headache days per month.
- A complete prior-therapy history listing each preventive medication tried by name, the dose, the duration, and the specific reason it failed (lack of efficacy, side effects, or contraindication), which directly answers a step-therapy denial.
- A letter of medical necessity that maps the patient's situation point by point to the plan's published Aimovig coverage criteria and cites them back to the reviewer.
- For a continuation or renewal appeal, objective response data such as a before-and-after reduction in monthly migraine days and reduced use of acute or rescue medication, showing the therapy is working.
How we approach the appeal
First identify which kind of denial you received, because the path differs. A step-therapy or prior-authorization denial is answered with a medical necessity appeal that documents the failed preventive trials and the migraine-day counts, quoting the plan's own Aimovig policy language such as its requirement to have tried "two or more" preventive agents. If the issue is formulary placement or a preferred competing CGRP product, file a formulary or tier exception arguing why Aimovig specifically is medically necessary, for example a prior inadequate response or intolerance to the preferred alternative. Always attach the letter of medical necessity, the prescriber's notes, and the headache diary, and request a peer-to-peer review if the first written appeal is upheld.
Aimovig appeal letter template
Copy this Aimovig appeal letter, fill in the brackets, and send it within your deadline. It is built on what overturns CGRP receptor inhibitor (monoclonal antibody) denials.
[Date] [Your name] · Member ID [ID] · Rx claim # [#] [Insurer or PBM] - Appeals Department Re: Appeal of Aimovig denial I am appealing the denial of Aimovig (erenumab (erenumab-aooe)). I request that the denial be overturned and Aimovig approved. 1. The denial. [Insurer] denied Aimovig stating, verbatim: "[paste the exact denial reason from your letter]." 2. Medical necessity. Aimovig is medically necessary for my condition. First identify which kind of denial you received, because the path differs. A step-therapy or prior-authorization denial is answered with a medical necessity appeal that documents the failed preventive trials and the migraine-day counts, quoting the plan's own Aimovig policy language such as its requirement to have tried "two or more" preventive agents. If the issue is formulary placement or a preferred competing CGRP product, file a formulary or tier exception arguing why Aimovig specifically is medically necessary, for example a prior inadequate response or intolerance to the preferred alternative. Always attach the letter of medical necessity, the prescriber's notes, and the headache diary, and request a peer-to-peer review if the first written appeal is upheld. 3. Step-therapy or formulary exception (if that was the reason): I have tried and failed [preferred drug(s)], with pharmacy records attached, or the preferred alternative is contraindicated because [reason]. I request a formulary or step-therapy exception. 4. My request. Approve Aimovig within the timeframe required by law. If the denial is upheld, please provide the specific criteria used, the reviewing clinician's credentials, and external-review instructions. Attached: prescriber letter of medical necessity, pharmacy and prior-trial records, and supporting clinical notes. Sincerely, [Your name]
Want it built and filed for you? Use the free generator, or have Apellica do it.
Internal appeals: 30 days pre-service, 60 days post-service, 72 hours urgent. File within 180 days of the denial.
$0 upfront. We assess fit first, then build and file the appeal for you.
- · The denial letter and your Explanation of Benefits (EOB)
- · Insurance ID, plan name, and the claim or prior-authorization number
- · Diagnosis with ICD-10 code and the prescriber's clinical notes
- · A record of treatments already tried and how they worked
Appealing a Aimovig denial by insurer
The path depends on who manages your benefit. The most common:
Coverage runs through the pharmacy benefit. Appeal the coverage determination and, when the drug is non-formulary, file a formulary or tier exception with a provider attestation that covered alternatives are unsuitable.
Publishes detailed prior-authorization criteria. A denial usually means a criterion was not documented. Appeal through a coverage review, with a formulary exception for excluded drugs.
Administers many UnitedHealthcare and employer plans. Appeals and exceptions follow the plan's published PA criteria; expedited review exists for urgent cases.
Internal appeal first, then independent external review. Pre-service decisions are generally made within 30 days, urgent within 72 hours.
Internal appeals and external review; pharmacy denials often route through OptumRx criteria.
Independent state plans, so criteria vary. Match the appeal to your specific BCBS plan, internal appeal first, then external review.
Frequently asked questions
My plan says I have to try cheaper migraine medicines first before Aimovig. Can I still get it covered?
Often yes. This is step therapy, and it can be satisfied two ways. Either document that you have already tried and failed or could not tolerate the required older preventives, such as a beta-blocker, a tricyclic antidepressant, or an anticonvulsant like topiramate, or request a step-therapy exception if those drugs are contraindicated for you. Listing each drug by name with the dose, how long you took it, and why it failed is what usually moves these appeals.
My insurer covers a different CGRP drug instead of Aimovig. What are my options?
You can file a formulary or tier exception. The strongest argument is a clinical reason that Aimovig specifically is needed, for example that you already tried the plan's preferred CGRP product and it did not work or caused side effects, or that you tolerate Aimovig's once-monthly injection and dosing. Your prescriber should state this in a letter of medical necessity that responds directly to the plan's criteria.
My Aimovig was approved before but now my renewal was denied. Why?
Most plans require proof that the drug is helping before they reauthorize it, commonly a reduction of about 50 percent in monthly migraine days or another documented meaningful improvement. A renewal denial usually means that response data was missing. Submitting a simple before-and-after comparison of your monthly migraine days, along with any drop in rescue medication use, generally resolves this.
Aimovig denied? We fight it for you.
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Start Your AppealThis page provides general information about appeal strategy. It is not legal or medical advice. Apellica is not a law firm. Outcomes depend on documentation, plan terms, and timing.