zolmitriptan (Zomig, Zomig 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: (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

12 months