Ajovy (fremanezumab-vfrm subcutaneous injection) — Cigna

Initial criteria

• Patient age ≥ 6 years and < 18 years
• Patient has ≥ 4 and < 15 migraine headache days per month prior to initiating a migraine-preventive medication
• If the patient is currently taking Ajovy, the patient has had a significant clinical benefit from the medication as determined by the prescriber (e.g., reduction in the overall number of migraine days per month or in number of severe migraine days per month)

Reauthorization criteria

• Patient continues to have a significant clinical benefit from Ajovy as determined by the prescriber

Approval duration

1 year