Nurtec ODT — Medical Mutual

Initial criteria

• Patient has a migraine diagnosis
• Patient age ≥ 18 years
• Patient has ≥ 4 and < 15 migraine headache days per month prior to initiating a migraine-preventive medication
• Patient has tried at least two standard prophylactic pharmacologic therapies, each from a different pharmacologic class
• Patient has had inadequate efficacy to both of those standard prophylactic therapies OR experienced adverse events severe enough to warrant discontinuation of both OR had inadequate efficacy to one standard prophylactic therapy and adverse events severe enough to warrant discontinuation of another

Reauthorization criteria

• If the patient is currently taking a CGRP antagonist, the patient has had a significant clinical benefit from the medication as determined by the prescriber

Approval duration

initial 3 months; reauth 1 year