zolmitriptan nasal spray — 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: currently using migraine prophylactic therapy OR unable to take migraine prophylactic therapies due to inadequate treatment response, intolerance or contraindication [Examples of prophylactic therapy include 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: 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