Nurtec ODT (rimegepant sulfate orally disintegrating tablets – Pfizer) — Cigna

Initial criteria

• Patient age ≥ 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 Nurtec ODT, patient has had a significant clinical benefit from the medication as determined by the prescriber (e.g., reduction in overall migraine days per month or reduction in severe migraine days per month)

Approval duration

1 year