Western Health Advantage
Nurtec (rimegepant)
Drugs for the Nervous System : Drugs for Migraine Headaches
  • PA Required
  • Acute Migraine:
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)

    Migraine Prevention:
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Documented Diagnosis: Yes

  • Prior Authorization: Acute Migraine:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 3 Month(s)
    Reauthorization Required: Yes

    Migraine Prevention:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 3 Month(s)

  • Quantity Limit: limit maximum 0.27 EA PER 1 day(s)
  • Step Therapy: ST Multiple Generics

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