sumatriptan (Imitrex, Tosymra, Onzetra Xsail, Zembrace SymTouch, Treximet) — CareFirst (Caremark)
Migraine headache
Initial criteria
- Patient does NOT have confirmed or suspected cardiovascular OR cerebrovascular disease OR uncontrolled hypertension
- Medication overuse headache has been considered AND ruled out
- Patient meets ONE of the following: (1) Patient is currently using migraine prophylactic therapy OR (2) Patient is unable to take migraine prophylactic therapies due to inadequate treatment response, intolerance or contraindication [Examples: divalproex sodium, topiramate, valproate sodium, metoprolol, propranolol, timolol, atenolol, nadolol, candesartan, amitriptyline, venlafaxine, erenumab, fremanezumab, galcanezumab, eptinezumab, rimegepant, atogepant]
- Patient meets ONE of the following: (1) The requested drug is NOT being used concurrently with another triptan 5-HT1 agonist OR (2) The requested drug is being used concurrently with another triptan 5-HT1 agonist AND the patient requires more than one triptan 5-HT1 agonist due to clinical need for differing routes of administration
Approval duration
12 months