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Frova (frovatriptan) — Blue Cross Blue Shield of Alabama

cluster headache

Preferred products

  • eletriptan
  • naratriptan
  • rizatriptan
  • sumatriptan
  • zolmitriptan tablets
  • zolmitriptan ODT tablets

Initial criteria

  • Target Agent(s) will be approved when ONE of the following is met:
  • The requested agent is eligible for continuation of therapy AND ONE of the following:
  • - The patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days OR
  • - The prescriber states the patient has been treated with the requested agent (starting on samples is not approvable) within the past 90 days AND is at risk if therapy is changed
  • OR ONE of the following:
  • - The patient has ONE of the following:
  • • Has a medication history of use in the past 90 days to ONE prerequisite agent OR
  • • Has intolerance or hypersensitivity to ONE prerequisite agent OR
  • • The patient has an FDA labeled contraindication to ALL prerequisite agent(s)

Reauthorization criteria

  • Continuation of therapy criteria: patient has been treated with the requested agent within the past 90 days or prescriber confirms risk if therapy changed.

Approval duration

12 months