Emgality — Highmark

Initial criteria

• If the treatment plan is to use two chemically distinct CGRP inhibitors in combination for preventive and acute use, the prescriber attests that the benefits of therapy outweigh the risks of concurrent use of both medications.

Reauthorization criteria

• The prescriber attests that the member has experienced a reduction in one of the following: reduction in the number of migraine days per month by at least 50% from baseline OR episodic migraines: a reduction in migraine days per month by at least 4 days from baseline OR chronic migraines: a reduction in migraine days per month by at least 5 days from baseline.
• Subsequent reauthorizations are subject to sustained improvements noted above.

Approval duration

initial 6 months (12 months for Delaware), reauth 12 months