We are implementing a process to review all requests for new patient consult appointments for migraine headache management, due to limited neurology providers in the practice.  Our appointment access for new patient consults is currently 12 weeks or longer.

These materials can help patients start with treatment sooner than our appointment access currently allows.

**Printed copies of these documents can be requested by calling (319) 398-1721. **

Pharmacologic Treatment for Episodic Migraine Prevention in Adults

Migraine Headache Prophylaxis

Migraine Medication Tips

Insurance resources for migraines

Coverage for chronic migraines (more than 15 migraines per month) vs. episodic migraines (4-14 migraines per month)- All are easier to get approved with episodic migraine diagnosis.

Abortive
  • Must try a minimum of 2 triptans with documentation of why medication was a failure
  • Nurtec is the preferred option over Ubrelvy for most insurance companies
  • Ubrelvy 10 tabs per 30day
  • Nurtec 8 tabs per 30days
  • Reyvow-8 tabs per 30days- 1 tab per 24hrs (some insurance only cover 4 tabs)
Preventative
  • Must try 3 different drug classes before Ajovy, Emgality or Aimovig, Vyepti will be approved
  • Beta Blocker-Propranolol, metoprolol, Nadolol, Atenolol, timolol
  • Antiepileptic- Depakote and Topamax
  • Tricyclic- amitriptyline, doxepin, Nortriptyline and Imipramine, Venlafaxine
  • New class. Angiotensin II receptor antagoinists- Candesartan, Ibersartan, valsartan
  • Peds only- Cyproheptadine
  • Nurtec 16 tabs per 30days-except for Amerigroup/Iowa Total care is 15 tabs per 30 days
    • Some insurances consider this a specialty med, and it needs to be 30 days.
  • Most insurances require a trial of preferred injectables before Qulipta or Nurtec will be approved
  • Reason for failure of previous tried meds and document number of migraines in the last few months when changing to Vypeti or Botox vs saying having more migraines (insurance needs a number based on diagnosis)
Wellmark Global non- formulary

Must try ALL options for prevention and abortive before the non-formulary will be approved.  Must try propranolol IR and ER, Depakote IR and ER. All injectables, Botox and ALL abortive triptans.  Also must try timolol as one of their formulary options.

Contraindications
  • Kidney stone with Topamax
  • Asthma with Propranolol
  • Triptan with history of stroke or cardiac conditions or hemiplegic migraines
  • Depakote - during childbearing age. Increased risk for fetal defects.
  • Topamax – Increased risk of cleft paletet during development, addon prenatal vitamin and folic acid 400-800mcg
BOTOX
  • Chronic migraines Dx- G43.709
  • Must try and fail 3 drug classes
  • Documentation of 15 or more migraines per month. Each migraine lasting 4 hrs or more.
  • Migraine symptoms-photophobia, phonophobia, nausea, etc
Vyepti
  • Provider to decide on 100mg or 300mg infusion every 3 months (Some insurance like Medicaid must start at 100mg infusion)
  • Documentation of meds tried and failed and number of migraines per month
PA Questions/ Documentation

Insurance will approve injectables for the first 3 months so its helpful to have patient return for new notes on migraine/ Headache improvement with documentation stating improvement of 50% or more, less abortive medication use.

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