Calcitonin gene-related peptide (CGRP) receptor antagonists for migraine prophylaxis
CGRP antagonists for migraine prophylaxis require prior authorization for coverage.
Criteria for initial 90-day trial:
- Diagnosis of chronic migraine, defined as headache on ≥ 15 days per month for > 3 months, which has the features of migraine headache on ≥ 8 days per month.
- Migraine diagnosis is causally related to an accepted industrial injury or occupational disease.
- The patient has kept a daily headache diary for at least 3 months prior to confirm diagnosis and establish baseline frequency, duration and quality of headaches.
- The patient has been screened for medication overuse headache, defined by the use of triptans for 10 or more days per month and/or the use of analgesics for 15 or more days per month. If present, discontinuation of the suspected medication(s) is recommended for 2 months.
- The patient has tried and failed at least 3 preferred prophylaxis drugs from at least 2 different classes (unless contraindicated):
- Anticonvulsants: divalproex sodium/valproate, topiramate
- Beta-blockers: metoprolol, propranolol, timolol
- Antidepressants: amitriptyline, venlafaxine
- The patient has not received botulinumtoxinA (Botox) injections for migraine prophylaxis in the previous 12 weeks, and will not receive it or other CGRP antagonists concurrently with approval.
- There are no contraindications to the use of CGRP antagonists: history of adverse reactions or hypersensitivity to the medication or any component thereof.
- CGRP antagonists are part of an agreed upon, time-limited, rehabilitative treatment plan with clearly stated treatment goals (e.g., participation in vocational rehabilitation and/or return to work).
Criteria for continued coverage:
- No serious adverse events experienced from treatment with CGRP antagonists.
- Migraine days per month are reduced by at least 50% from baseline.
- Use of the CGRP antagonist resulted in documented rehabilitative benefit.
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