REYVOW — Blue Cross Blue Shield of Kansas
diagnosis other than acute migraine treatment
Reauthorization criteria
- Patient has been approved previously for the requested agent through the plan’s Prior Authorization process
- For acute migraine treatment: patient has had clinical benefit with the requested agent AND one of the following applies: (a) requested agent is NOT REYVOW OR (b) requested agent is REYVOW AND patient will NOT use it in combination with another acute migraine therapy (5HT-1F, acute use CGRP, ergotamine, triptan)
- Medication overuse headache has been ruled out
- For diagnosis other than acute migraine treatment: patient has had clinical benefit with the requested agent
- Patient does NOT have any FDA labeled contraindications to the requested agent
Approval duration
12 months