Will Aimovig be covered by public drug plans in Canada?
We have been following the arrival of CGRP antibodies (Aimovig, Emgality) in Canada.
Below are a few comments on access and coverage.
What is the drug coverage system like in Canada?
Canadians pay their medications either through private insurance companies (with plans often linked with their work), public insurance systems or out-of-pocket (no insurance).
Estimates state that 60% of Canadians have private coverage, 30% public and 10% out of pocket. This varies depending on the province.
Private plans vary a lot, even with the same company between different people.
Are private payers covering for CGRP antibodies?
At present time, some private payers will reimburse CGRP MABs, often not 100%. Many will cover 80%. If one dose costs 540$, that would leave 108$ per month to be paid by the person. Patient Support Programs (PSPs) offered by the companies (Novartis, Eli Lilly) may be able to pay this cost for a while. This partial support is called a co-pay.
** If you are paying more than 540$ per dose of Aimovig or more than 625$ per dose of Emgality, it is because there are additional fees, for example pharmacy fees. This is a different question to be addressed later.
Are provincial public payers covering CGRP antibodies?
Not at present time. Public payers are waiting for the recommendation of CADTH, a public institution that assesses the value of medications. Health Canada’s job is to check that medications are safe and are effective. CADTH check if they are cost-effective, meaning are they worth paying for from a public health care perspective.
See here about CADTH: https://www.cadth.ca/
How can CADTH decide if a medication should be covered?
The final decision is from the provincial governments. CADTH makes a recommendation. This is a very serious process done by teams of experts. The input of patients is welcome. Migraine Canada did submit a report on erenumab and detailed what it means to live with migraine (thanks to everyone who participated to our survey). The team looks at the expected results of the drug, the disability and costs linked to the disease, and then sees if the drug has a real value for people and society.
Read the report sent to CADTH: (PDF link)
When will the decision be made public?
According to the CADTH website, the decision could be made public in January. Other countries with national PharmaCare type systems (UK and Australia) have already decided not to cover Aimovig.
See here for more information: https://www.cadth.ca/erenumab
What would it mean if the decision is made not to recommend Aimovig?
It would mean that the Health Ministries of the provinces (excluding Quebec, that has its own drug assessment authority called INESSS) would probably decide not to cover Aimovig. Canadians living with migraine and having a public coverage would then have to pay out-of-pocket for the drug or subscribe to an additional private plan.
CGRP MABs like Aimovig seem effective for some people. Why would they not be covered?
That is a question of value for money. Migraine is a stigmatized disease. Its impact on life is often underestimated. Its cost on society is also underestimated. There is research on this. The value of the treatment could be difficult to fully appreciate. Also, migraine is very frequent (1/10 at least), and the burden on the public system would be bigger than for a rare disease like multiple sclerosis (1/1000).
Would there be other consequences of this decision?
Yes. Here are some things that could happen:
- This decision sends a strong signal about the evaluation of the whole CGRP antibody class. Other antibodies (Emgality, Ajovy) could be evaluated in a similar way as the results from the studies and the costs are quite similar.
- The public decision may influence private payers who are currently covering Aimovig. They could decide to decrease their coverage.
- Some patients are currently receiving financial support from Patient Support Programs (PSPs) from Novartis and Eli Lilly. This support is provided in waiting for a long-term coverage. If public plans decide not to cover, it may be that PSPs decide not to support people with public plans (this is only a hypothesis of course).
Would Aimovig be covered for everyone with migraine if the decision was positive?
No. Criteria for coverage would probably be >8 days per month with a migraine, and at least 2 previous failures with traditional oral preventives (amitriptyline, beta-blockers, topiramate etc.) That’s probably fair as the CGRP MABs are expensive and traditional options may work for a good number of people.
What can I do if I want to take action and tell the government and authorities that migraine is a serious disease and that treatments should be accessible?
At present time, CADTH is evaluating the data.
We have investigated the possibility of an online petition to send to the Health Ministries of different provinces. CADTH is funded by the provinces, so advocating to the provincial government could make sense. An online check found that governments do not accept e-petitions. We still have a lot to learn about advocacy in migraine and headache world. Considering that there was no national association until 2018, we are making progress!
Questions and comments:
Hi. Just checking to see how the approval process for Aimovig is progressing. I have been on it for a trial period, and after the first 3 months it really started to work well. I now am down to 1 mild migraine requiring a dose of Zomig per month. Its been especially good these last few months since the weather has been so variable and that is a big factor in my migraines. I have had them since I was a child and it does run in the family. Since I am down to one more dose, I am afraid to return to the old normal. I see my neurologist next month and I’m hoping to get on another CGRP trial. Our private drug plan, Great West, will not cover this medication yet since to them it is only a quality of life issue, and provinces haven’t picked it up yet. Hopefully the government will see that this works for many migraineurs and adds it. Thanks for your efforts and fingers crossed that approvals will come sooner than later.
Was on Go Program now it’s finished. Same problem, Same boat, no coverage. I have saved doses. Feel like chatting about what to do please contact me : Katie SparkleandBespoke@gmail.com
Hi Katie,
Im trying to find information on how to apply to the Aimovig Go program in Canada? I cant find any information online. Does a doctor do that for me or do i apply personally?
Hi Karen
I’ve been using Aimovig for just over a year and a half now….it’s been a total lifesaver. The GO Program covered me for about the first year of use, and now I’m paying 80% out of pocket. Novartis is still covering 20%, but not sure how long that will continue. I am with Blue Cross, and they will not cover it, yet the drugs DIN is listed in their medication list. I’ve contacted SunLife and Manulife to see if they cover it, and really got no response. SunLife just wanted me to switch to them, and then they would let me know!!! According to this link on Migraine Canada, they say that some private insurers will cover a portion. I wish they would just tell us who they are!!
Hello Nancy, I am with Sunlife and they cover it at 100% but they take an approval process from my dr. Every year. It depends on what individual employee has as coverage from their employer. It varies even within company plans. Sun life has been cutting back coverage on many things. Good luck finding coverage.
I’ve been on the trial plan for Aimovig for about 6 months now and it’s turned my life around completely. I went from having a chronic migraine almost every single day to 3 or 4 a month (which I ease by taking a triptan). I received the email stating the trial was ending regardless of how many refills were issued to the client and I am devastated as my husband and I have no insurance. We looked into single insurance plans and many of them were going to be well over $300 a month while only providing a total coverage of $1000 a year for prescription medication. At the present cost of each Aimovig injection, this wouldn’t even cover two months worth. I’m extremely disappointed about losing access to the one medication that has worked in treating my chronic migraines and now I must anticipate going back to take 20+ triptans a month, enduring a chronic migraine almost every day once again. The cost of medication is beyond outrageous.
Hi Natasha. It certainly sucks. We have finally found something that works but the cost is prohibitive. Ugh. Covid will make things worse since governments are now going into huge budget deficits to fight the virus. Migraines are off the radar now. My neuro is hoping Aimovig has given my brain a reset. I hope so, I’ve been having migraines since I was a kid. Good luck to you.
Was on Go Program now it’s finished. Same problem, Same boat, no coverage. I have saved doses. Feel like chatting about what to do please contact me : Katie SparkleandBespoke@gmail.com
Was on Go Program now it’s finished. Same problem, Same boat, no coverage. I have saved doses. Feel like chatting about what to do please contact me : Katie SparkleandBespoke@gmail.com
I’m down to my last two months with Aimovig, received both injections together…. I am going to make the switch to Emgality and use their patient support program as I don’t have private insurance and I suffer from dusky chronic migraines, never ending! 24/7 and aimovig saved my life! I can’t go back to relying on narcotics, especially when I also have Hemiplegic attacks
hello Jill.can you please point me in the direction of this program as its only in the USA not available in canada.
I would appreciate more info on the Emgality patient support program. I too am in the same boat. I was taking rizatriptan almost daily before the Aimovig injections, and now have a daily mild headache, but can usually alleviate with the Tylenol – caffeine headache medication, and only take 5 or 6 triptans a month compared to 25+ before.
So, if Emgality has a similar program as the Go program for Aimovig, I would appreciate your help with info to contact them.
Hello,
I am in the same boat, cronic migraines for the last 6-8 years for sure. Was on Aimovig since Feb 2019 and was given 1 month notice that I would not be on the trial that was to be 2 years back in May. I am back to getting more migraines and do not qualify for coverage on my benefits at work. I cannot afford $600-700 a month and I was doing 2 shots then just one of 140.
Is their Patient Support program better than Aimovig?
I just got off the phone with a rep from the company. I do not have any drug coverage through insurance or the government. They will only cover 20% of the $600 monthly cost. What a joke.
Migraine Canada is aware of the situation and how patients are being impacted with the program ending. The CADTH recommendation is expected any day now. Once we have this recommendation, we will have a better idea of approach we will need to take to advocate for patients.
CEDC recommendationcame thru Sept. 2020. Now how do we get coverage in BC?
I too am on my last 2 injections of 140mg. I love this drug. It has truly improved quality of life for me by softening the impact of the migraines I do get. If my insurance carrier doesn’t cover the standard 80% I don’t know what to do as other meds don’t seem to work for me.
Thank you for the update, Wendy. As someone who also has had their life changed by Aimovig (went from everyday migraines to less than 15 a month) and now is being threatened with all this progress being taken away, I am thankful to know that there are people fighting for us to continue to access this life altering treatment. It is SO appreciated. I can only hope and pray they see the value for money.
I too have been taking aimovig under the Novartis go program. After 7 years of almost daily migraine, the results are nothing short of miraculous. No l get about 3 or 4 migraines a month but they are shorter in duration and less intense. My life has almost returned to ‘normal’.
I was distressed to learn the go program was abruptly cancelled after being told I would receive 2 years free on compassionate grounds. I have only had 8 months of this 2 year offer. There is finally a medication that works for migraine but the cost is prohibitive.
Just keeping fingers crossed that Pharmacare in BC will approve this drug.
I came here to see if the program would be extended or a decent co-pay offered. I’m gutted that only two doses (140 mg) left. It’s the only med that broke the cycle of chronic migraine. Only milder episodic and manageable attacks now. I’m in Quebec
I too , only have 1 Aimovig month left. Aimovig is a Life saver and is the only drug that works for me over 25 years Without Aimovig I spend most of my time in bed trying to recover from a migraine and only to get another No life
I am going to check with my neurologist to see if Emgality has a plan similar to Aimovig
I have suffered from migraines for 40 years, and they have been chronic daily migraine for many of those years. Aimovig has been an absolute life changer for me. I have been using it for the last 16 months, and now suffer from maybe 1 to 2 milder migraines per month. The Novartis GO program has ended, but they will co-pay 20%, so now I will be paying about $500 out of pocket each month for the 140mg injection. My Blue Cross will not cover it!! Migraine is a debilitating disease, and many people like myself have been unable to work because of them. Our insurance companies need to step it up, and get these CGRP Antibodies on their plans.
My daughter is disabled has epilepsy, cerebral palsy,blind, and developmentally delayed with all that she has migraines daily sometimes multiple times daily, she was on aimovig trial she was almost migraine free now no more shots and no government coverage to continue getting the shot. Her migraines are back and i cant afford to cover 540.00 a month.. please she needs this medication
Aimovig certainly has been a life changer for me, being a chronic migraineur x 40 years. My neurologist said I was the type of patient they hate to see – have tried and eventually failed at everything offered. Aimovig has made my life bearable once again – I can actually say I know what it feels like to NOT have a pounding headache! It was suggested I apply for Trillium drug coverage (in Ontario), which has finally been approved, however I still have to pay $250 out of pocket q3m due to my low income. The first $250 applies for the first rx received in that quarter, which of course would be the Aimovig injection. Unfortunately, even at that reduced price, it is not possible for me to pay for this drug. I want and NEED this drug for quality of life. There must be something the company can do to help people like me – who have no choice but to work, forcing ourselves to do so through the pain, living on pain killers (unfortunately I cannot take triptans). I miss work, causing even less income, let alone hardship in the office as I always have a full schedule. Thank God I received a year free – covered by the patient support program. But not sure what I will do without this med – just cannot go back to how things were prior to Aimovig. HELP!!!
Do you know if Trillium covers Aimovig? I spoke to my nurse today and she said they would not cover it?
The file is currently with the pCPA which is where the provinces and manufacturer negotiate price. Migraine Canada is advocating to move this file forward quickly so it can get covered through provincial drug plans.
No they do not, have spoke to them on several occasion also had dr do an EAP for it
I’ve just read the July 2020 Recommendation by the CADTH in Canada, posted Sept. 11, 2020 here:
https://www.cadth.ca/erenumab
The CADTH recommends coverage, so does this mean that BC PharmaCare will cover it? Thank you
Any update anyone?
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