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Mdwise Prior Authorization Criteria MDWISE PRIOR AUTHORIZATION CRITERIA SEROTONIN RECEPTOR AGONISTS (TRIPTANS) FORMULARY STATUS Preferred, Pays at Point-of-Sale (First Line) Sumatriptan (generic) Tablet: 25mg, 50mg, 100mg; Nasal Spray: 5mg, 20mg; Subcutaneous Injection: 4mg/0.5mL, 6mg/0.5mL FORMULARY STATUS Preferred, Requires Step Therapy (Second Line) RELPAX (eletriptan) Tablet: 20mg, 40mg ZOMIG (zolmitriptan) Tablet: 2.5mg, 5mg; Nasal Spray: 5mg ZOMIG-ZMT (zolmitriptan) Orally Disintegrating Tablet: 2.5mg, 5mg FORMULARY STATUS Non-Preferred, Requires Prior Authorization (Third Line) AMERGE (naratriptan) Tablet: 1mg, 2.5mg AXERT (almotriptan) Tablet: 6.25mg, 12.5mg FROVA (frovatriptan) Tablet: 2.5mg MAXALT (rizatriptan) Tablet: 5mg, 10mg MAXALT-MLT (rizatriptan) Orally Disintegrating Tablet: 5mg, 10mg SUMAVEL DOSEPRO (sumatriptan) Subcutaneous Injection: 6mg/0.5mL TREXIMET (sumatriptan/naproxen) Tablet: 85mg/500mg PA CRITERIA FOR APPROVAL Preferred Agents (First Line): Diagnosis of migraine headaches. Diagnosis of cluster headaches (sumatriptan injection only). An automatic approval at the point-of-sale will occur if the quantities prescribed do not exceed 9 tablets per 30 days, 6 nasal spray units per 30 days, and 2 injections per 30 days. Preferred Agents (Second Line): Diagnosis of migraine headaches. Documented trial and failure or intolerance to sumatriptan. If the above conditions are met, the request will be approved with 12 month duration with quantity limits not to exceed 9 tablets per 30 days or 6 nasal spray units per 30 days; if the above conditions are not met, the request will be referred to a Medical Director for medical necessity review. Non-Preferred Agents (Third Line, Excluding Treximet): Diagnosis of migraine headaches. Documented trial and failure or intolerance to sumatriptan, Relpax, and Zomig/Zomig-ZMT. If the above conditions are met, the request will be approved with 12 month duration with quantity limits not to exceed 9 tablets per 30 days; if the above conditions are not met, the request will be referred to a Medical Director for medical necessity review. Treximet: Requests for Treximet should be directed to using the two individual agents (sumatriptan and naproxen). Quantities Greater than Allowed per 30 Days if Prior Authorization Criteria Met: If the patient requires doses greater than the set limits above after meeting approval, the request will be referred to a Medical Director for medical necessity review. FDA INDICATIONS Serotonin receptor agonists are indicated for the acute treatment of migraine attacks with or without aura in adults. They are not indicated for prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. Imitrex injection is also indicated for treatment of cluster headache episodes in adults. FDA INDICATIONS Serotonin receptor agonists are indicated for the acute treatment of migraine attacks with or without aura in adults. They are not indicated for prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. Imitrex injection is also indicated for treatment of cluster headache episodes in adults. DOSAGE AND ADMINISTRATION Amerge: Tablet: 1 or 2.5mg at onset; may repeat after 4 hours. Do not to exceed 5mg in a 24 hour period. Axert: Tablet 6.25 or 12.5mg at onset; may repeat after 2 hours. Do not exceed 2 doses in a 24 hour period. Frova: Tablet 2.5mg at onset; may repeat after 2 hours. Do not exceed 7.5mg in a 24 hour period. sumatriptan: Tablet: 25, 50 or 100mg at onset; may repeat after 2 hours. Do not exceed 200mg in a 24 hour period. Nasal Spray: 5 or 20mg (1 spray) at onset; may repeat after 2 hours. Do not exceed 40mg in a 24 hour period. Subcutaneous Injection: 4 or 6mg subcutaneously at onset; may repeat in 1 hour. Do not exceed 6mg/dose and 12mg in a 24 hour period. Maxalt: Tablet: 5 or 10mg at onset; may repeat after 2 hours. Do not exceed 30mg in a 24 hour period. Orally Disintegrating Tablet: 5 or 10mg at onset; may repeat after 2 hours. Do not exceed 30mg in a 24 hour period. Relpax: Tablet: 20 or 40mg at onset; may repeat after 2 hours. Do not exceed a 40mg/dose or 80mg in a 24 hour period. Treximet: Tablet: 85mg/500mg at onset; may repeat after 2 hours. Do not exceed 170mg/1000mg in a 24 hour period. Sumavel Dosepro: Subcutaneous Injection: 6mg subcutaneously at onset; may repeat in 1 hour. Do not exceed 12mg in a 24 hour period. Zomig: Tablet: 2.5 or 5mg at onset; may repeat after 2 hours. Do not exceed 10mg in a 24 hour period. Orally Disintegrating Tablet: 2.5 or 5mg at onset; may repeat after 2 hours. Do not exceed 10mg in a 24 hour period. Nasal Spray: 5mg (1 spray) at onset; may repeat after 2 hours. Do not exceed 10mg in a 24 hour period. REFERENCES 1. Amerge Prescribing Information. GlaxoSmithKline. February 2010. 2. Axert Prescribing Information. Ortho-McNeil Pharmaceuticals. April 2009. 3. Frova Prescribing Information. Endo Pharmaceuticals, Inc. April 2007. 4. Imitrex (Tablets and Nasal Spray) Prescribing Information. GlaxoSmithKline. February 2010. 5. Imitrex (Subcutaneous Injection) Prescribing Information. GlaxoSmithKline. February 2010. 6. Maxalt and Maxalt-MLT Prescribing Information. Merck & Co., Inc. December 2009. 7. Relpax Prescribing Information. Pfizer. May 2008. 8. Treximet Prescribing Information. GlaxoSmithKline. December 2009. 9. Sumavel DosePro Prescribing Information. Zogenix, Inc. July 2009. 10. Zomig, Zomig-ZMT, and Zomig Nasal Spray Prescribing Information. AstraZeneca Pharmaceuticals. October 2008. 11. Facts and Comparisons, St. Louis, 2010 eFacts CliniSphere Version ISBN 1-57439-036-8. 12. Lexi-Comp Online. Available from: http://online.lexi.com.db.usip.edu/crlonline. Accessed April 2010. 13. Micromedex Online Available from: http://www.thomsonhc.com.db.usip.edu/hcs/librarian. Accessed April 2010.. Revision/Review Date: MAC 10/12/2011 Associated Policy: Prior Authorization of Medications 236.200 .
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