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Emgality — Highmark

chronic migraine

Initial criteria

  • age ≥ 18 years
  • diagnosis of migraine (ICD-10: G43) classified as either episodic migraine (4–14 headache days per month) OR chronic migraine (≥15 headache days per month of which ≥8 are migraine days)
  • prescriber attests to baseline average monthly migraine days
  • headaches are not caused by medication rebound or overutilization or due to lifestyle factors
  • therapeutic failure or intolerance to one agent from two different plan-preferred prophylactic migraine medication classes OR all are contraindicated (from: alpha-agonists, ACE inhibitors/ARBs, anti-epileptic drugs, beta-blockers, calcium channel blockers, SNRIs, tricyclic antidepressants)