Aimovig — Blue Cross Blue Shield of New Mexico

Preferred products

• Aimovig
• Ajovy
• Emgality
• Nurtec ODT

Initial criteria

• ONE of the following:
• A. The requested agent is being used for migraine prophylaxis AND BOTH of the following:
• 1. ONE of the following:
• A. The requested agent is eligible for continuation of therapy AND the following: prescriber states patient has been treated with the requested agent (not samples) within past 90 days AND is at risk if therapy is changed OR
• B. ALL of the following:
• 1. ONE of the following:
• A. The patient has had ≥15 headache days per month for ≥3 months (chronic migraine) AND ≥8 migraine headache days per month for ≥3 months AND the requested agent and strength are FDA labeled for chronic migraine prophylaxis OR
• B. The patient has 4–14 monthly migraine days (episodic migraine) AND the requested agent and strength are FDA labeled for episodic migraine prophylaxis AND
• 2. ONE of the following:
• A. The requested agent is a preferred agent or stand-alone agent for the requested indication OR
• B. The patient meets stage four advanced metastatic cancer criteria with FDA-approved use for that condition OR is currently stable on the requested agent OR has tried and had an inadequate response to ONE preferred agent OR has intolerance/hypersensitivity/contraindication to ONE or ALL preferred agent(s) OR preferred agent discontinued due to inefficacy/adverse event OR preferred agent expected to be ineffective, cause adherence barrier, worsen comorbidity, or cause harm OR preferred agent not in best interest based on medical necessity OR patient tried another drug in same pharmacologic class discontinued due to inefficacy/adverse event
• 3. Medication overuse headache ruled out
• 4. Patient will NOT be using requested agent in combination with another prophylactic use CGRP
• OR B. The requested agent is being used for episodic cluster headache AND ALL:
• 1. ≥5 cluster headache attacks
• 2. ≥2 cluster periods lasting 7–365 days
• 3. Cluster periods separated by pain-free remission period ≥3 months
• 4. ONE of the following:
• A. Stage four advanced metastatic cancer criteria met OR
• B. Patient has tried and had inadequate response/intolerance to ≥1 prerequisite agent (verapamil, melatonin, corticosteroids, topiramate, lithium) OR contraindication to ALL prerequisite agents
• 5. Requested agent and strength are FDA labeled for episodic cluster headache treatment
• 6. Medication overuse headache ruled out
• OR C. The requested agent is being used for acute migraine treatment AND ALL:
• 1. ONE of the following:
• A. Stage four advanced metastatic cancer criteria met OR
• B. Patient has tried and had inadequate response to ONE triptan agent OR has intolerance/hypersensitivity to ONE triptan OR contraindication to ALL triptan agents
• 2. Patient will NOT use requested agent in combination with another acute migraine therapy (5HT-1F, acute-use CGRP, ergotamine) for the indication
• 3. ONE of the following:
• A. The requested agent is preferred or stand-alone for the indication OR
• B. Stage four advanced metastatic cancer criteria OR patient stable on requested agent OR has tried/inadequate response/intolerance/contraindication to ONE or ALL preferred agent(s) OR discontinued preferred agent for inefficacy/adverse event OR preferred agent expected to be ineffective, cause adherence barrier, worsen comorbidity, or cause harm OR preferred agent not in best interest OR tried another drug in same mechanism discontinued for inefficacy/adverse event
• 4. Requested agent and strength are FDA labeled for acute migraine treatment
• 5. Medication overuse headache ruled out
• OR D. The patient has another FDA labeled indication for the requested agent and route of administration OR E. The patient has another compendia-supported indication, with age within labeling or supported use, and no FDA-labeled contraindications

Approval duration

Migraine prophylaxis - 6 months; all other indications - 12 months