Ajovy (fremanezumab) — United Healthcare

Initial criteria

• Diagnosis of migraines
• Used for the preventive treatment of migraines
• Medication will not be used in combination with another CGRP antagonist or inhibitor used for the preventive treatment of migraines (e.g., Nurtec ODT, Qulipta, Vyepti)

Reauthorization criteria

• 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 the preventive treatment of migraines (e.g., Nurtec ODT, Qulipta, Vyepti)

Approval duration

12 months