Migranal (dihydroergotamine) — Highmark

Preferred products

• generic sumatriptan nasal spray
• plan-preferred generic zolmitriptan nasal spray
• generic dihydroergotamine nasal spray

Initial criteria

• Diagnosis of acute migraine headaches with or without aura (ICD-10: G43)
• Prescriber attests member experiences significant nausea and vomiting and requires a non-oral route of administration
• Member has experienced therapeutic failure, contraindication, or intolerance to generic sumatriptan nasal spray
• Member has experienced therapeutic failure, contraindication, or intolerance to plan-preferred generic zolmitriptan nasal spray
• If request is for brand Migranal, member has experienced therapeutic failure or intolerance to generic dihydroergotamine nasal spray

Reauthorization criteria

• Prescriber attests that the member has experienced positive clinical response to therapy
• If request is for a brand product with a generic equivalent, member has experienced therapeutic failure or intolerance to the generic equivalent product

Approval duration

12 months