Nurtec ODT (rimegepant) — Highmark
acute treatment of migraine
Preferred products
- generic oral sumatriptan
- generic oral rizatriptan
- generic oral zolmitriptan
Initial criteria
- Member age ≥ 18 years
- Diagnosis of migraine (ICD-10: G43), classified as acute migraine headaches with or without aura
- Therapeutic failure, contraindication, or intolerance to one of the following: generic oral sumatriptan OR generic oral rizatriptan OR generic oral zolmitriptan
- If using two chemically distinct CGRP inhibitors for preventive and acute use, prescriber attests benefits outweigh risks of concurrent use
Reauthorization criteria
- Prescriber attests the member has experienced positive clinical response to therapy
Approval duration
initial 6 months; reauthorization 12 months