The past few years have brought major progress in how we prevent and manage migraine. CGRP-targeting medications like Aimovig, Emgality, Vyepti, Nurtec ODT, and Qulipta represent a shift in both the science and strategy of treating this condition.

They're often better tolerated and more effective than older medications, and they allow for more personalized care, whether that means a daily pill, a monthly injection, or a quarterly infusion.

But while the science has advanced, insurance coverage hasn’t kept up. Patients are still being denied access to these medications due to outdated policies, arbitrary formulary changes, and one-size-fits-all coverage rules. At Claimable, we’re working with patients, providers, and advocacy partners to challenge these barriers—and win.

If you’re facing a denied claim for a migraine medication, read on to understand the tactics insurance companies take to limit access to these treatments – and what you can do to get covered.

Understanding the migraine treatment landscape

As a migraine sufferer, I know that migraines are more than a bad headache. It’s a disabling neurological disease that affects over 40 million people in the U.S. and is a leading cause of missed work and reduced quality of life.

CGRP (calcitonin gene-related peptide) medications have transformed our ability to treat and prevent migraine. Unlike older medications developed for other conditions (like epilepsy or depression), CGRP drugs are designed specifically for migraine. They target the biological mechanisms believed to drive attacks, offering relief with fewer side effects.

Why migraine coverage is so challenging

Even though these medications are FDA-approved and supported by professional guidelines, insurance plans often:

• Require you to fail older, less effective drugs first
• Only cover one CGRP drug despite clinical differences
• Force patients to switch medications mid-year due to rebate deals
• Approve treatment only temporarily, requiring re-authorization every few months
• Use vague or bureaucratic reasons to deny access altogether

This system doesn’t reflect the complexity of migraine or the individual needs of patients. It reflects cost-saving tactics that delay care.

Common migraine insurance denial reasons – and how we fight them

Step Therapy Requirements

What it is: Insurance insists you try and fail older medications (like triptans, topiramate or amitriptyline) before approving CGRP drugs.

Why it’s wrong: These older medications often come with tough side effects and weren’t designed for migraine. The American Headache Society supports CGRP drugs as a first-line option.

How we fight it: We submit detailed appeals outlining your treatment history, side effects from older meds, and professional guidelines that justify bypassing step therapy.

Formulary exclusions

What it is: Only one CGRP medication is covered. All others are denied.

Why it’s wrong: CGRP drugs aren’t interchangeable. A daily pill may work better for one person than a monthly injection. Side effects and effectiveness vary.

How we fight it: We explain the medical rationale for your chosen medication, using provider notes and evidence that shows why it’s not just a preference—it’s a necessity.

Mid-Year medication switching

What it is: Your plan changes coverage mid-year due to PBM rebate deals, forcing you to switch medications from a medication you’re stable on to what they prefer.

Why it’s wrong: Migraine treatment relies on consistency. Switching meds can cause rebound attacks and destabilize your care.

How we fight it: We focus on treatment stability and cite ERISA protections (if applicable) to challenge the fairness of mid-year changes.

Short-term or conditional approvals

What it is: You get approved for 30 or 60 days at a time, with constant re-authorization requirements.

Why it’s wrong: Migraine is chronic. Short-term approvals create anxiety, disrupt care, and burden providers.

How we fight it: We argue for long-term approval based on your condition and medication response, using both legal framing and clinical support.

"Not medically necessary" determinations

What it is: Your insurer denies a medication without a clear reason, claiming it’s not necessary.

Why it’s wrong: This ignores your provider’s judgment and contradicts clinical guidelines.

How we fight it: We present peer-reviewed studies, your provider’s rationale, and documentation showing how the treatment improves your quality of life.

Administrative or documentation barriers

What it is: Missing forms, technicalities, or unclear instructions result in denials.

Why it’s wrong: The insurer is making medical decisions by burying you in paperwork. Most people give up and concede to insurance demands. It’s generally understood that patients who accept non-medical switches have adverse side effects and poorer outcomes. 

How we fight it: We ensure everything is submitted cleanly and correctly, with language that anticipates common administrative objections.

How Claimable builds strong migraine appeals

As a patient, you have the right to challenge these denied claims. Insurers are required to comply with state and federal laws – which often require their denial rationale to be based on medical necessity, FDA standards, and other clinical, legal, and policy standards.

That means a strong appeal should include clinical evidence, legal standards, and policy compliance to hold insurance accountable to deliver your care and coverage. At Claimable, we use a multi-layered approach:

• Personal narrative: We capture your history, prior treatments, and how migraine affects your life. In particular this could be how you’re not able to enjoy your hobbies or do basic things like drive safely at night. We hear of patients becoming socially isolated. 
• Clinical evidence: We include the latest guidelines, studies, and medication-specific data. This includes the guidance from the American Headache Society, and other peer-reviewed studies and randomized controlled trials proving these medications are right for you. 
• Legal leverage: We reference plan terms, medical necessity requirements, and ERISA protections. This helps reinforce your rights to have a full and fair review of your care. An insurance doctor who has never met you shouldn’t get to make the call. 
• Collaborative advocacy: Your primary care doctor or neurologist can refer you for an appeal if they have a denial, or you can simply add their letter of medical necessity to your appeal to increase its strength.

Why this work matters – unlocking migraine coverage

The medications now available can change lives. But they only work if you can access and stay on them. No one should be forced to suffer just because their insurer hasn’t updated its playbook.

At Claimable, we don’t just file paperwork. We build appeals that reflect who you are, what you’ve been through, and why your treatment plan matters. If your migraine medication has been denied, disrupted, or downgraded, we’ll help you fight back—with precision, evidence, and persistence. Your journey matters to us.

Facing an insurance denial for Aimovig, Emgality, Nurtec or other migraine medication?

We’re here to help. Let’s make the system work for you—not against you.

Get started on your migraine appeal today.

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