Find detailed information on commercial health plan formularies and prior authorization requirements for CGRP-targeting migraine treatments. Learn about step therapy criteria, quantity limits, and plan-specific policies to guide your coverage decisions across different insurers.
PBM formulary criteria shown are representative of Utilization Management offered. Variations in the prior authorization may occur.
Payers may require treatment trial, contraindication, or intolerance of different classes
Payers may have varying requirements for patients. Upon PA approval, reauthorization may be required after 12 months.
Payers may allow only a set amount of usage over a predefined time period.
Preventive
No steps.
Yes
Anthem Commercial Formularies
All
Yes
Yes
Cigna Commercial Formularies
Acute
Yes
Yes
Preventive
Yes
Yes
CVS Caremark PDL – Standard Control
Acute
Yes
Yes
Express Scripts National Preferred Formulary
Acute
Yes
Yes
Prime Therapeutics Commercial Formularies
Acute
Yes
Yes
Preventive
Step x 2
Yes
Yes
Preventive
Yes
Yes
