Get Aimovig Prior Authorization Request Form (page 1 Of 2)

Filling out the Aimovig Prior Authorization Request Form is an essential step in ensuring that coverage for Aimovig is obtained in a timely manner. This guide provides clear, step-by-step instructions for completing the form accurately and efficiently online.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in your designated online editor.
2. Begin by entering the member information. This includes the member's name, insurance ID number, and date of birth, among other required fields.
3. Next, fill out the provider information. Provide the provider's name, contact phone number, specialty, and street address, ensuring all fields are completed accurately.
4. In the medication information section, specify the medication name and strength. If you are requesting a brand-name drug, mark the corresponding checkbox.
5. Now move on to the clinical information section. Answer the questions regarding the continuation of therapy and provide the diagnosis information as required.
6. If applicable, select the medications the member has tried, including the dosage and duration of trials, ensuring that all relevant details are thoroughly documented.
7. Complete any additional required questions for episodic or chronic migraines based on the nature of the request.
8. Lastly, review the prescriber attestation and ensure the prescriber’s signature is included before finalizing the form.
9. Once all sections are filled out and verified for accuracy, you can save the changes, download the form, print it, or share it as necessary.

Complete your Aimovig Prior Authorization Request Form online today to streamline your request process.