approved, initial authorization will be for six (6) months.
Aimovig (erenumab) or
Emgality (galcanezumab) is considered medically necessary in members meeting the
18 years of age or older; AND
of migraine headaches; AND
for the prevention of migraines; AND
Documentation of at least eight (8) migraines per month; AND
had inadequate response to an adequate trial (60 days) of a product from at
least two of the drug classes below:
Blockers (e.g. atenolol, propranolol)
Anticonvulsants (e.g. topiramate, gabapentin, divalproex)
Antidepressants (e.g. amitriptyline, venlafaxine)
Channel Blockers (e.g. verapamil); AND
not be using Aimovig or Emgality with Botox for prevention of migraines.
decrease of > 50% in migraine frequency from baseline; AND
use of acute migraine medications; AND
therapy with Botox.