zolmitriptan nasal spray — CareFirst (Caremark)

Initial criteria

• Patient does NOT have confirmed or suspected cardiovascular OR cerebrovascular disease OR uncontrolled hypertension
• Request is for sumatriptan injection OR sumatriptan nasal spray OR zolmitriptan nasal spray (e.g., Imitrex Injection, Imitrex Nasal Spray, Onzetra Xsail, Tosymra, Zomig Nasal Spray)
• Patient meets ONE of the following: the requested drug is NOT being used concurrently with another triptan 5-HT1 agonist OR the requested drug is being used concurrently with another triptan 5-HT1 agonist AND patient requires more than one triptan 5-HT1 agonist due to clinical need for differing routes of administration

Approval duration

12 months