Aimovig — Medical Mutual

Initial criteria

• Patient is age ≥ 18 years
• Patient has ≥ 4 migraine headache days per month (prior to initiating a migraine-preventive medication)
• Patient has tried at least two standard prophylactic (preventive) pharmacologic therapies, each from a different pharmacologic class
• Patient meets ONE of the following criteria (i, ii, or iii): i) Inadequate efficacy to both therapies OR ii) Adverse events severe enough to warrant discontinuation of both therapies OR iii) Inadequate efficacy to one therapy AND adverse events severe enough to warrant discontinuation of another therapy
• Site of care medical necessity is met

Reauthorization criteria

• If the patient is currently taking a CGRP antagonist, the patient has had a clinical benefit from the medication as determined by the prescriber
• Site of care medical necessity is met

Approval duration

3 months initial; 1 year continuation