Reyvow — CareFirst (Caremark)

Initial criteria

• Diagnosis of acute treatment of migraine with or without aura in an adult patient
• Patient has experienced an inadequate treatment response or an intolerance to TWO triptan 5-HT1 agonists OR has a contraindication that would prohibit a trial of triptan 5-HT1 agonists
• If additional quantities are being requested, medication overuse headache has been considered AND ruled out
• Patient is currently using migraine prophylactic therapy (e.g., divalproex sodium, topiramate, valproate sodium, metoprolol, propranolol, timolol, atenolol, nadolol, candesartan, amitriptyline, venlafaxine, erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, atogepant) OR patient is unable to take migraine prophylactic therapy due to an inadequate treatment response, intolerance, or contraindication

Approval duration

12 months