Nurtec ODT — United Healthcare

acute treatment of migraine

Initial criteria

Option 1 (acute):
Diagnosis of migraine headaches with or without aura
Used for acute treatment of migraine
Medication will not be used in combination with another acute calcitonin gene-related peptide receptor (CGRP) antagonist (e.g., Ubrelvy, Zavzpret)
OR Option 2 (preventive):
Diagnosis of episodic migraines
Used for 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., Aimovig, Ajovy, Emgality, Qulipta, Vyepti)

Documentation of positive clinical response to therapy
One of the following:
1) Use is for the acute treatment of migraine AND medication will not be used in combination with another acute calcitonin gene-related peptide receptor (CGRP) antagonist (e.g., Ubrelvy, Zavzpret)
OR
2) Use is for the preventive treatment of migraines AND medication will not be used in combination with another CGRP antagonist or inhibitor used for the preventive treatment of migraines (e.g., Aimovig, Ajovy, Emgality, Qulipta, Vyepti)

12 months