Botox — Medica
Chronic migraine headache prevention
Preferred products
- Aimovig
- Ajovy
- Emgality
- Qulipta
- Vyepti
Initial criteria
- Patient meets the standard Botulinum Toxins – Botox Prior Authorization Policy criteria; AND
- Patient has tried at least one of the following: Aimovig, Ajovy, Emgality, Qulipta, Vyepti [documentation required]; OR patient is currently receiving the requested product
Approval duration
1 year