Step 3 of 3: Confirm your eligibility

The following questions are to be answered by the patient

1.
Are you 18 years of age or older and a resident of one of the 50 United States or Puerto Rico, or a US territory?
*
YES NO

2.
Do you have commercial or private healthcare insurance?
*
YES NO

3.
Are you enrolled in a health plan purchased through the federal Health Insurance Marketplace at healthcare.gov or a State Exchange such as Covered California or the NY State of Health? *
YES NO

4.
Are you a Medicare beneficiary? *
YES NO

5.
Are you enrolled in a Part D plan?
YES NO

6.
Are you a retiree, or a spouse or dependent of a retiree, and receiving prescription drug coverage from a former employer, union health and welfare plan, or multi-employer health and welfare plan?
YES NO

7.
Are you enrolled in any other government healthcare program that pays for prescription drugs? This includes programs funded either by the federal or state government. For example, Medicaid, Veterans Affairs (VA), the Department of Defense (DoD), TRICARE, or a state pharmaceutical assistance program. *
YES NO

8.
You agree to notify Amgen if at any time your answers to any of these questions change. In addition, if at any time you begin enrolled in a plan that provides prescription drug coverage under any Medicare or any other federal or state government program, you will no longer be able to use this card and must stop your participation in the program. Do you understand and agree with this statement? *
YES NO





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Important Safety Information

Before starting Aimovig (erenumab-aooe), tell your healthcare provider about all your medical conditions, including if you are allergic to rubber or latex, pregnant or plan to become pregnant, breastfeeding or plan to breastfeed.

Tell your healthcare provider or pharmacist about all the medicines you take, including any prescription and over-the-counter medicines, vitamins, or herbal supplements.

What are possible side effects of Aimovig?

The most common side effects of Aimovig are pain, redness, or swelling at the injection site and constipation.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all of the possible side effects of Aimovig. Ask your healthcare provider or pharmacist for more information. Call your healthcare provider for medical advice about side effects.

You are encouraged to report side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Click here for Full Prescribing Information and Patient Product Information.

Approved Use

Aimovig is a prescription medicine used for the preventive treatment of migraine in adults.