{"id":630863,"date":"2024-12-31T15:10:58","date_gmt":"2024-12-31T20:10:58","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=630863"},"modified":"2026-04-13T15:42:08","modified_gmt":"2026-04-13T19:42:08","slug":"does-aetna-cover-nurtec","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/does-aetna-cover-nurtec\/","title":{"rendered":"Does Aetna cover Nurtec?"},"content":{"rendered":"

Nurtec ODT<\/span><\/a> (rimegepant) is a brand-name drug approved by the Food and Drug Administration (FDA) to treat acute migraine and prevent episodic migraine in adults. Healthcare providers will prescribe this medication to patients who have attempted other types of migraine management or are sensitive to other classes of drugs, such as serotonin-receptor agonists (triptans). If you are insured through Aetna, Nurtec may be covered by your plan, but coverage can vary, and prior authorization is often required.\u00a0<\/span><\/p>\n

Does Aetna cover Nurtec?<\/span><\/h2>\n

Aetna may cover Nurtec. However, not all Aetna plans are the same. Aetna offers many individual plans, corporate plans, Medicare plans, and <\/span>Medicaid<\/span><\/a> plans, all with varying degrees of coverage and drug formularies (lists of covered drugs and their pricing tiers). You can use <\/span>Aetna\u2019s medication lookup<\/span><\/a> tool to find out whether your plan covers Nurtec and whether there are any requirements or restrictions.<\/span><\/p>\n

Factors affecting Aetna\u2019s coverage of Nurtec<\/span><\/h2>\n

Pfizer<\/span><\/a>, the manufacturer of Nurtec, says most insurance companies are likely to cover Nurtec. However, there may be some requirements that patients and their healthcare providers must adhere to first. Many insurance companies require <\/span>prior authorization<\/span><\/a>. In this process, your healthcare provider will have to prove to Aetna that the medication is medically necessary.\u00a0<\/span><\/p>\n

\u201cSome insurance plans also require their insureds to complete step therapy before prescribing a medication,\u201d says Edmond Hakimi, DO, a dual-board-certified internal medicine physician and the medical director at Wellbridge in Calverton, New York. <\/span>Step therapy<\/span><\/a>, also known as \u201cfail first,\u201d is when an insurance company requires patients to try one or more preferred medication(s) for their medical conditions before moving to a more expensive drug.<\/span><\/p>\n

How much does Nurtec cost?<\/span><\/h2>\n

If you do not have insurance, or if you can\u2019t get prior authorization through Aetna, you may need to pay out-of-pocket for Nurtec ODT. The average retail price of one box of 8 disintegrating tablets is <\/span>about $1,410 without insurance<\/span><\/a>. Drug prices fluctuate, however, and vary by pharmacy.\u00a0<\/span><\/p>\n

How much does Nurtec cost with Aetna?<\/span><\/h3>\n

Drug coverage for Nurtec ODT varies depending on your plan. To give you an example, for the <\/span>2025 Aetna Better Health Premier Plan<\/span><\/a>, which is a Medicaid plan, Nurtec ODT (75 mg) is on Tier 2 with a $0 copay. However, prior authorization is required, and the quantity limit is 16 tablets for 30 days.<\/span><\/p>\n

How to check whether your Aetna plan covers Nurtec\u00a0<\/span><\/h2>\n

Nurtec ODT coverage depends on what Aetna health insurance plan you have. You can look at your plan’s formulary to determine if you have coverage for this medication. As mentioned earlier, Aetna\u2019s medicine search tool makes it easy to search through thousands of prescription medications to determine which ones are covered under your plan and exclusions of certain drugs.\u00a0<\/span><\/p>\n

You can also log into the member website at <\/span>Aetna.com<\/span><\/a> to view the drug list for your plan in your Summary of Benefits and Coverage (SBC). If you need assistance navigating Aetna\u2019s website, you can contact one of its representatives by dialing the phone number on the back of your insurance card.\u00a0<\/span><\/p>\n

What to do if insurance won\u2019t cover Nurtec<\/span><\/h2>\n

If your insurance company initially denies your Nurtec prescription, there may be other options to consider. Your healthcare professional can work with your insurance plan to obtain coverage for this drug. Your plan may require a prior authorization (PA). If a PA is required, your healthcare provider\u2019s office can submit clinical documentation to show that Nurtec is medically necessary for you.\u00a0<\/span><\/p>\n

If Aetna denies the prior authorization request, your healthcare provider can appeal the decision by sending additional supporting clinical information to your plan. If Aetna denies the appeal, you may wish to look into prescription discount programs, like SingleCare, or manufacturer programs to help lower your cost on this prescription. You can also talk to your healthcare provider about Nurtec alternatives.<\/span><\/p>\n

Your healthcare professional and pharmacist can help you navigate the insurance process.<\/span><\/p>\n

How to get Nurtec without insurance<\/span><\/h2>\n

If you find that your Aetna plan doesn\u2019t list Nurtec ODT as one of its covered drugs, there are other options you can pursue to lower your out-of-pocket costs.\u00a0<\/span><\/p>\n

SingleCare<\/span><\/a> can help you save money on Nurtec ODT if your copay for Nurtec is too high or if it’s not one of your covered drugs. Savings vary by pharmacy, but you could pay $923 instead of $1,410 for one box of 8 orally disintegrating tablets. To find a SingleCare coupon, search for your preferred pharmacy on the Nurtec coupon page on SingleCare\u2019s website and click \u201cGet free coupon.\u201d You\u2019ll then receive a coupon to save to your phone or print. You\u2019ll show this coupon card to your pharmacist to get your discount.\u00a0<\/span><\/p>\n

Some patients may be eligible for patient assistance programs or manufacturer savings programs that can help lower the cost of Nurtec. You can contact the manufacturer to see if you qualify for any of these programs.<\/span><\/p>\n

Nurtec alternatives<\/span><\/h2>\n

If your Aetna plan recommends trying <\/span>Nurtec alternatives<\/span><\/a> before it will cover Nurtec, your healthcare provider may recommend any of the following, depending on your medical history and whether you\u2019re using Nurtec to prevent migraine or to treat acute migraine:<\/span><\/p>\n