Approved Use: Aimovig® is a prescription medicine used for the preventive treatment of migraine in adults.
What type of insurance do you use to pay for your Aimovig® prescription at the pharmacy?
Are you eligible for Medicare but receive prescription drug coverage from a former employer, union, or welfare plan?*
Please provide the information below to activate your Copay Card and participate in AimAlly™ support programs.
Required information*
Please provide at least one phone number*
Would you like to enroll in AimAlly™ support?
You have an ally throughout your journey. We're here for you from the start with helpful tools, resources, community content, and more to support you on your path to fewer monthly migraine days.
In addition to the Aimovig® Copay Card, below are even more resources to help you navigate your experience.
Text message refill reminders and your Copay Card sent straight to your phone
Get courtesy reminders to refill your prescription and renew your Copay Card.
By clicking here, you are agreeing to the Terms and Conditions
The Aimovig AimAlly™ 90-Day Start Program
A simple way to get the resources and support you need to navigate your first 3 months on Aimovig and beyond, all in one place.
Required information*
Telephone Consumer Protection Act (TCPA) Consent*
I consent to receive marketing calls and texts from and on behalf of Amgen, made with an autodialer or prerecorded voice, at the phone number(s) provided. I understand that my consent is not required or a condition of purchase. The number of messages will vary based on your program selections. Message and data rates may apply. Text STOP to opt out and HELP for help.
I give permission for my healthcare providers, pharmacies, service providers and their contractors (“Healthcare Providers”), and health insurers and their contractors (“Insurers”), to disclose my personal information, including information about my health insurance benefits, prescriptions, my medical condition and history, adherence to my treatment, and my general health (“personal information”) to Amgen Inc., its affiliates, business partners, and agents (“Amgen”) for the following purposes:
Give permission for my healthcare providers, pharmacies, service providers and their contractors ("Healthcare Providers"), and health insurers and their contractors ("Insurers"), to disclose my personal information, including information about my health insurance benefits, prescriptions, my medical condition and history, adherence to my treatment, and my general health ("personal information") to Amgen Inc., its affiliates, business partners, and agents ("Amgen") for the following purposes:
(i) help to verify or coordinate insurance coverage or otherwise obtain payment for my treatment with Aimovig® (erenumab-aooe);
(ii) coordinate my receipt of and payment for Aimovig®;
(iii) facilitate my access to Aimovig®;
(iv) provide me with information about Amgen products, disease education and awareness and management programs, and promotional materials related to my condition or treatment;
(v) manage the AimAlly™ support program;
(vi) If I am eligible, coordinate the Aimovig® Copay Card program, including managing and communicating with me about the copay support options available to me;
(vii) provide me with medication reminders and support; and
(viii) conduct quality assurance, surveys, and other internal business activities in connection with the AimAlly™ support program and other related programs.
I give permission to Amgen to disclose my personal information to my Healthcare Providers for the purposes described above. I understand that my Healthcare Providers and Insurers may receive remuneration (payment) from Amgen in exchange for disclosing my personal information to Amgen and/or for providing me with therapy support services.
I understand that once my personal information is disclosed, it may no longer be protected by federal privacy law. I understand that I may refuse to sign this authorization. I also may revoke (cancel) or get a copy of this authorization at any time by calling 833-246-6844 or writing to PO Box 2205, Morristown, NJ 07962. I also understand that if a Healthcare Provider or Insurer is disclosing my personal information to Amgen on an authorized, ongoing basis, my cancellation with Amgen will be effective with respect to any such Healthcare Provider or Insurer as soon as they receive notice of my cancellation.
My refusal or future revocation will not affect my medical treatment or insurance benefits; however, if I revoke this authorization, I may no longer be able to participate in the AimAlly™ support program and related programs. If I revoke this authorization, Amgen will stop using or sharing my information (except as necessary to end my participation in the program), but my revocation will not affect uses and disclosures of personal information previously disclosed in reliance upon this authorization. I understand that this authorization will remain valid for 5 years after the date of my signature, unless I revoke it earlier. I also understand that the AimAlly™ support program may change or end at any time without prior notification.
I agree to be contacted by Amgen by mail, email, telephone calls and text messages at the numbers and address(es) provided on this Form for all purposes described in this Patient Authorization. I also agree to be contacted by Amgen and others on its behalf by telephone calls and text messages made by or using an automatic telephone dialing system or pre-recorded voice, at the number(s) provided on this form, for all nonmarketing purposes, including but not limited to sending me materials and asking for my participation in surveys.
I confirm that I am the subscriber for the telephone number(s) provided and the authorized user for the e-mail address(es) provided, and I agree to notify Amgen promptly if any of my number(s) or address(es) change in the future. I understand that my wireless service provider’s message and data rates may apply. I understand that Amgen does not permit my personal information to be used by its business partners for their own separate marketing purposes. I understand and agree that personal information transmitted by e-mail and cell phone cannot be secured against unauthorized access.
I certify that I am the patient or its legal representative and that I have read and agree to the above patient authorization.*
It is important that every patient read and understand the full Aimovig® (erenumab-aooe) Copay Card Terms and Conditions. The following summary is not a substitute for reviewing the Terms and Conditions in their entirety.
As further described below, in general:
I. ELIGIBILITY
Eligibility Criteria: Subject to program limitations and terms and conditions, the Aimovig®(erenumab-aooe) Copay Card is open to patients who have an Aimovig prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs related to Aimovig, up to program limits. There is no income requirement to participate in this program.
This offer is not valid for patients whose Aimovig prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs. It is not valid for cash-paying patients or where prohibited by law. A patient is considered cash-paying where the patient has no insurance coverage for Aimovig or where the patient has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of an Aimovig prescription. This offer is only valid in the United States, Puerto Rico, and the US territories.
II. PROGRAM BENEFITS
The Aimovig® Copay Card helps provide out-of-pocket support to eligible patients for their Aimovig prescription up to program limits. See PROGRAM DETAILS for full description.
The Aimovig® Copay Card offer does not cover out-of-pocket costs for any patient whose selected coverage option under their commercial insurance plan does not apply Aimovig® Copay Card payments to satisfy the patient's co-payment, deductible, or co-insurance for Aimovig. Patients with these plan limitations are not eligible for the Aimovig® Copay Card but may be eligible for other needs-based assistance provided by Amgen. These programs are often referred to as accumulator adjustment programs. If you believe your commercial insurance plan may have such limitations, please contact AimAlly at 1-833-AIMOVIG (833-246-6844).
The Aimovig® Copay Card also may provide a reduced benefit amount, unilaterally determined by Amgen in its sole discretion, to satisfy the out-of-pocket cost-sharing requirement for any patient whose plan or plan agent (including, but not limited to, a Pharmacy Benefit Manager (PBM)) requires enrollment in the Aimovig® Copay Card as a condition of the plan or PBM waiving some or all of an otherwise applicable patient out-of-pocket cost-sharing amount. These programs are often referred to as copay maximizer programs. If you believe your commercial insurance plan may have such limitations, please contact AimAlly at 1-833-AIMOVIG (833-246-6844). Health plans, specialty pharmacies, and Pharmacy Benefit Managers (individually and collectively "Plan Administrators") are prohibited from enrolling patients in the Aimovig® Copay Card. Plan Administrators are prohibited from assisting patients with enrollment in the Aimovig® Copay Card. The patient, or his/her legal representative, must personally enroll in the Aimovig Copay in order to be eligible for program benefits. If at any time a patient begins receiving prescription drug coverage under any state or government program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran Affairs programs), the patient will no longer be able to use this card and they must contact AimAlly™ at 1-833-AIMOVIG (833-246-6844) (Monday through Friday, from 8AM-9PM ET) to stop their participation in this program.
Patients may not seek reimbursement for the value received from the Aimovig® Copay Card from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure regarding your participation in the Aimovig® Copay Card of your insurance carrier or Pharmacy Benefit Manager. Restrictions may apply. Offer is subject to change or discontinuation without notice. This is not health insurance.
III. PROGRAM DETAILS
With the Aimovig® Copay Card, a commercially insured patient who meets eligibility criteria may pay as little as a $5 copay per month for their Aimovig monthly out-of-pocket costs.
Our AimAlly™ Support Team can provide information on options available.
Monday – Friday, 8 am – 9 pm ET
You can also review our patient FAQs.
Sign up for the AimAlly™ 90-Day Start Program:
a simple way to get the resources and support you need to navigate your first 3 months on Aimovig®, all in one place.
learn more at Aimovig.comBased on the information you provided, it appears that you are not eligible for the Aimovig® Copay Card.
If you have questions about the Aimovig Copay Card, including questions about eligibility, please call the AimAlly™ Support Team at:
Monday – Friday, 8 am – 9 pm ET
You can also review our patient FAQs.
Sign up for the AimAlly™ 90-Day Start Program:
a simple way to get the resources and support you need to navigate your first 3 months on Aimovig®, all in one place.
learn more at Aimovig.comWe will review your details and contact you with any questions.
Still looking for answers? Don't hesitate to call our AimAlly™ Support Team with questions you may have at 833-AIMOVIG (833-246-6844), Monday – Friday, 8 am – 9 pm ET.
Based on the information you provided, it appears that you are not eligible for the Aimovig® Copay Card.
However, Amgen Safety Net Foundation may be able to help.
Please contact them at amgensafetynetfoundation.com.
Still looking for answers? Don't hesitate to call our AimAlly™ Support Team with questions you may have at 833-AIMOVIG (833-246-6844), Monday – Friday, 8 am – 9 pm ET.
Sign up for the AimAlly™ 90-Day Start Program:
a simple way to get the resources and support you need to navigate your first 3 months on Aimovig®, all in one place.
learn more at Aimovig.comCall our AimAlly™ Support Team to learn about available options.
NOTICE: The AimAlly™ mobile program ("Program") for Aimovig® (erenumab-aooe) is not intended to be a source of medical advice or care. Please contact your healthcare provider if you have any questions about your medical condition, diagnosis, treatment or care.
1. By opting into the AimAlly™ mobile program ("Program"), in which you can receive your Aimovig® Copay Card via text, you consent to receive approximately 5 text messages and/or push notifications per month from EngagedMedia. Such messages may include, but are not limited to, claims reversal notifications, refill reminders, fill confirmation, website information, etc. Your mobile service provider is NOT liable for delayed or undelivered messages.
The Program runs on the short code 246-46. Amgen will not charge you to use this Program; however, your Wireless Service Provider may charge for sending and/or receiving messages and for airtime.
2. To stop receiving text messages, text STOP to 246-46. DOING SO WILL ONLY OPT YOU OUT OF THE AIMOVIG® (erenumab-aooe) MOBILE PROGRAM SMS COMMUNICATIONS; you will remain opted in to any other Amgen text message program(s) to which you separately opted in. You may unsubscribe from the Mobile Wallet SMS Message Program at any time by disabling push notifications. You may unsubscribe from the eCard by removing the eCard from your Mobile Wallet.
3. To request more information or to obtain help, text HELP to 246-46. You can also call customer service at 833-246-6844.
4. You represent that you are the account holder for the mobile telephone number(s) that you provide to opt in to the texting program.
5. You agree to promptly notify Amgen if you change your mobile telephone number. You may notify Amgen of a number change at any time. Opt out of the program by texting STOP to 246-46 and re-enrolling in the program with your new mobile telephone number. You also agree to identify Amgen and parties texting on its behalf in full for all claims, expenses, and damages related to or caused (in whole or in part) by your failure to notify Amgen and parties texting on its behalf if you change your telephone number, including but not limited to all claims, expenses, and damages related to or arising under the Telephone Consumer Protection Act.
6. Message and data rates may apply to each text message sent or received in connection with the texting program, as provided in your mobile telephone service rate plan, in addition to any applicable roaming charges. Charges are both billed and payable to your mobile service provider or deducted from your prepaid account. Amgen does not impose a separate fee for sending text messages.
7. You understand that data obtained from you by Amgen or its partners, in connection with your registration for, and use of, the Program may include, for example, your phone number, related carrier information, device information, and elements of pharmacy claim information. This data may be used to administer this program and to provide program benefits such as savings offers, information about your prescription, refill reminders, as well as program updates and alerts sent directly to your device.
8. You understand that data obtained from you in connection with your registration for, and use of, the Program may include, for example, your phone number, related carrier information, device information, and elements of pharmacy claim information. This data may be used to administer this program and to provide program benefits such as access offers, information about your prescription, refill reminders, as well as program updates and alerts sent directly to your device. Please read Amgen's full Privacy Statement, which is incorporated by reference into these Terms.
9. In addition to the data use practices described in the Privacy Statement, we may send you Offer-related push notifications when your device is in the physical proximity of your pharmacy or healthcare provider. This is done through geofencing technology, which is built in to your device. Your device's location will not be known or tracked by Amgen or its service providers. Nonetheless, you may opt out of geofencing and receiving these notifications at any time by (1) disabling location services for your Mobile Wallet app in your device's settings, (2) disabling notifications (i.e., automatic updates) within the Mobile Wallet app, or (3) removing the eCard from your Mobile Wallet by selecting "Remove Pass" within the Mobile Wallet app.
10. Amgen will not be liable for any delays in the receipt of any SMS messages, as delivery is subject to effective transmission from your network operator.
11. The service is available only on these US participating mobile carriers: Verizon Wireless, Sprint, Nextel, Boost Mobile, T-Mobile, AT&T, Alltel, ACS Wireless, Bluegrass Cellular, Carolina West Wireless, Cellcom, Cellular One of East Central Illinois (ECIT), Cincinnati Bell, Cricket Wireless, C Spire Wireless, Duet IP (AKA Max/Benton/Albany), Element Mobile, Epic Touch, GCI Communication, Golden State Cellular, Hawkeye (Chat Mobility), Hawkeye (NW Missouri Cellular), Illinois Valley Cellular (IVC), Inland Cellular, iWireless, Keystone Wireless (lmmix/PC Management), MetroPCS, Mobi PCS, Mosaic Telecom, MTPCS/Cellular One (Cellone Nation), Nex-Tech Wireless, nTelos, Panhandle Telecommunications, Pioneer, Plateau, Revol Wireless, Rina-Custer, Rina-All West, Rina-Cambridge Telecom Coop, Rina-Eagle Valley Comm, Rina-Farmers Mutual Telephone Co, Rina-Nucla Nutria Telephone Co, Rina-Silver Star, Rina-South Central Comm, Rina-Syringa, Rina-UBET, Rina-Manti, Simmetry Wireless, South Canaan (Cellular One of NEPA), Thumb Cellular, Union Wireless, United Wireless, U.S. Cellular, Viaero Wireless, Virgin Mobile, West Central Wireless (includes Five Star Wireless).
12. You acknowledge that the reliability of the timeliness of Program refill notifications depends upon, the information you provide, which includes, but is not limited to, phone number and device information, elements of claims information related to your prescription, and the functionality of your device. Be sure to accurately provide information so you receive notifications on time. This Program is not intended to replace the Patient Instructions for Use and any other information provided to you by your healthcare provider, which are intended to be the sources of information on which you should rely to understand how to use Aimovig®.
13. DISCLAIMER: The Program is provided "as is." Amgen, EngagedMedia and its partners make no warranties, express or implied, regarding the functionality or accessibility of the Program or the timeliness, contents or reliability of any refill reminders, fill confirmations, claims reversal notifications or any other SMS messages or push notifications, and expressly disclaim any implied warranty of merchantability or fitness for a particular purpose. To the maximum extent permitted by law, Amgen and its partners hereby disclaim and will not be liable for any direct, indirect, consequential, special, incidental, punitive or any other damages or injury arising from or relating in any way to your use of the Program, including but not limited to any costs or expenses or loss of insurance coverage for Aimovig® resulting from non-receipt or untimely receipt of any notifications or inaccessibility of the Program.
14. Amgen may suspend or terminate your receipt of text messages if it believes you are in breach of these Mobile Program Terms and Conditions. Your receipt of text messages is also subject to termination in the event that your mobile telephone service terminates or lapses. Amgen reserves the right to modify or discontinue, temporarily or permanently, all or any part of the text messaging services you receive, with or without notice.
15. Amgen may revise, modify, or amend these Mobile Program Terms and Conditions at any time. Any such revision, modification, or amendment shall take effect when it is posted to Amgen's website. You agree to review these Mobile Program Terms and Conditions periodically to ensure that you are aware of any changes. Your continued consent to receive text messages and include the eCard on your Mobile Wallet will indicate your acceptance of those changes.
It is important that every patient read and understand the full Aimovig® (erenumab-aooe) Copay Card Terms and Conditions. The following summary is not a substitute for reviewing the Terms and Conditions in their entirety.
As further described below, in general:
I. ELIGIBILITY
Eligibility Criteria: Subject to program limitations and terms and conditions, the Aimovig®(erenumab-aooe) Copay Card is open to patients who have an Aimovig prescription and who have commercial or private insurance, including plans available through state and federal healthcare exchanges. This program helps eligible patients cover out-of-pocket costs related to Aimovig, up to program limits. There is no income requirement to participate in this program.
This offer is not valid for patients whose Aimovig prescription is paid for in whole or in part by Medicare, Medicaid, or any other federal or state programs. It is not valid for cash-paying patients or where prohibited by law. A patient is considered cash-paying where the patient has no insurance coverage for Aimovig or where the patient has commercial or private insurance but Amgen in its sole discretion determines the patient is effectively uninsured because such coverage does not provide a material level of financial assistance for the cost of an Aimovig prescription. This offer is only valid in the United States, Puerto Rico, and the US territories.
II. PROGRAM BENEFITS
The Aimovig® Copay Card helps provide out-of-pocket support to eligible patients for their Aimovig prescription up to program limits. See PROGRAM DETAILS for full description.
The Aimovig® Copay Card offer does not cover out-of-pocket costs for any patient whose selected coverage option under their commercial insurance plan does not apply Aimovig® Copay Card payments to satisfy the patient's co-payment, deductible, or co-insurance for Aimovig. Patients with these plan limitations are not eligible for the Aimovig® Copay Card but may be eligible for other needs-based assistance provided by Amgen. These programs are often referred to as accumulator adjustment programs. If you believe your commercial insurance plan may have such limitations, please contact AimAlly at 1-833-AIMOVIG (833-246-6844).
The Aimovig® Copay Card also may provide a reduced benefit amount, unilaterally determined by Amgen in its sole discretion, to satisfy the out-of-pocket cost-sharing requirement for any patient whose plan or plan agent (including, but not limited to, a Pharmacy Benefit Manager (PBM)) requires enrollment in the Aimovig® Copay Card as a condition of the plan or PBM waiving some or all of an otherwise applicable patient out-of-pocket cost-sharing amount. These programs are often referred to as copay maximizer programs. If you believe your commercial insurance plan may have such limitations, please contact AimAlly at 1-833-AIMOVIG (833-246-6844). Health plans, specialty pharmacies, and Pharmacy Benefit Managers (individually and collectively "Plan Administrators") are prohibited from enrolling patients in the Aimovig® Copay Card. Plan Administrators are prohibited from assisting patients with enrollment in the Aimovig® Copay Card. The patient, or his/her legal representative, must personally enroll in the Aimovig Copay in order to be eligible for program benefits. If at any time a patient begins receiving prescription drug coverage under any state or government program (including but not limited to Medicare, Medicaid, TRICARE, Department of Defense, or Veteran Affairs programs), the patient will no longer be able to use this card and they must contact AimAlly™ at 1-833-AIMOVIG (833-246-6844) (Monday through Friday, from 8AM-9PM ET) to stop their participation in this program.
Patients may not seek reimbursement for the value received from the Aimovig® Copay Card from any third-party payers, including a flexible spending account or healthcare savings account. Participating in this program means that you are ensuring you comply with any required disclosure regarding your participation in the Aimovig® Copay Card of your insurance carrier or Pharmacy Benefit Manager. Restrictions may apply. Offer is subject to change or discontinuation without notice. This is not health insurance.
III. PROGRAM DETAILS
With the Aimovig® Copay Card, a commercially insured patient who meets eligibility criteria may pay as little as a $5 copay per month for their Aimovig monthly out-of-pocket costs.