Ajovy (fremanezumab) Letter of Medical Necessity
Ajovy (fremanezumab) PA criteria are similar to Aimovig: documented migraine frequency and failure of multiple oral preventives.
FDA-Approved Indications
- ● migraine prevention in adults
Why Ajovy Prior Authorization Gets Denied
The most common denial reasons across major payers:
- 1. Two oral preventive trials not documented
- 2. Headache diary missing
- 3. Step therapy through preferred CGRP
What to Include in a Ajovy Letter of Medical Necessity
Document migraine days, disability score, prior preventives with reasons for failure or intolerance, and any contraindications to alternatives.
Key clinical evidence to cite:
- ✓ HALO EM, HALO CM, FOCUS trials
Relevant guidelines:
- 📖 AHS Position Statement
Ajovy Prior Authorization Criteria
Standard criteria across major US payers for Ajovy. Specific criteria vary by plan — RxCheckUp tailors each LMN to your patient's exact payer policy.
Typical step therapy requirements:
- → Two oral preventive trials not documented
- → Step therapy through preferred CGRP
Required documentation:
- ✓ ICD-10 diagnosis code with specificity
- ✓ Prior therapy history with dates, doses, and discontinuation reasons
- ✓ Specialist evaluation (where applicable)
- ✓ Baseline disease activity or biomarker results
- ✓ Clinical rationale citing FDA labeling or guidelines
Approval details:
Initial approval: typically 6 months. Renewal: 12 months with documented clinical response.
Payers Covering Ajovy
RxCheckUp tailors each LMN to the specific payer's medical policy and step therapy requirements:
Ajovy Prior Authorization FAQ
Why was my Ajovy prior authorization denied?
The most common denial reasons for Ajovy are: Two oral preventive trials not documented; Headache diary missing; Step therapy through preferred CGRP.
What should a Ajovy Letter of Medical Necessity include?
Document migraine days, disability score, prior preventives with reasons for failure or intolerance, and any contraindications to alternatives.
Which payers cover Ajovy?
Ajovy is covered by major US payers including UnitedHealthcare, Aetna, Cigna, BCBS, though formulary tier and prior authorization criteria vary.