Aimovig (erenumab) — United Healthcare

Migraine prevention

Initial criteria

Diagnosis of migraine consistent with The International Classification of Headache Disorders, 3rd edition
One of the following: (a) 4 to 7 migraine days per month and at least one of: (1) Less than 15 headache days per month OR (2) Provider attests this is the member’s predominant headache diagnosis (i.e., primary driver of headaches is not a different, non-migrainous condition) OR (b) ≥ 8 migraine days per month
Failure (after a trial of at least 2 months; 30 days in CT, KY, MS) OR contraindication OR intolerance to two of the following prophylactic therapies (document name and date tried): beta-blocker (atenolol, metoprolol, nadolol, propranolol, or timolol); candesartan (Atacand); divalproex sodium (Depakote/Depakote ER); onabotulinumtoxinA (Botox); SNRI [duloxetine (Cymbalta), venlafaxine (Effexor/Effexor XR)]; topiramate (Topamax); TCA [amitriptyline (Elavil), nortriptyline (Pamelor)]
Medication will not be used in combination with another CGRP antagonist or inhibitor used for preventive treatment of migraines (e.g., Ajovy, Nurtec ODT, Qulipta, Vyepti)

Patient has experienced a positive response to therapy, demonstrated by a reduction in headache frequency and/or intensity
Medication will not be used in combination with another CGRP antagonist or inhibitor used for preventive treatment of migraines (e.g., Nurtec ODT, Qulipta, Vyepti)

12 months