Nurtec ODT (rimegepant) — Highmark

Initial criteria

• age ≥ 18 years
• diagnosis of migraine (ICD-10: G43) classified as episodic migraine (4–14 headache days per month)
• prescriber attests to: (a) baseline average monthly migraine days, (b) headaches not due to medication rebound/overutilization or lifestyle factors, AND (c) therapeutic failure or intolerance to one (1) agent from two (2) different prophylactic migraine medication classes OR all are contraindicated (alpha-agonists; ACE inhibitors or ARBs; anti-epileptics; beta-blockers; calcium channel blockers; SNRIs; tricyclic antidepressants)