Reyvow (lasmiditan) — Highmark
acute migraine headaches with or without aura
Preferred products
- generic oral sumatriptan
- generic oral rizatriptan
- generic oral zolmitriptan
Initial criteria
- Diagnosis of acute migraine headaches with or without aura (ICD-10: G43)
- Therapeutic failure, contraindication, or intolerance to one of the following: generic oral sumatriptan OR generic oral rizatriptan OR generic oral zolmitriptan
Reauthorization criteria
- Prescriber attests the member has experienced positive clinical response to therapy
Approval duration
initial 6 months; reauthorization 12 months