UnitedHealthcare
Tymlos (abaloparatide)
Hormones : Drugs for Menopause and Bone Loss
  • ST_APPLIES
  • Quantity Limit: Limited 1 per fill, 2 per month.
  • Migraine:
    Duration: 3 Month(s)
    Documented Diagnosis: Yes
    Medical Test Required: No
    Reauthorization Required: Yes
    Duration of Reauthorization: = 1 year(s)
    Migraine Frequency: 4 per month
    Is supporting documentation required for initial approval: No
    Is supporting documentation required for re-approval: No
    Policy Contains Verbiage for Botulinum Interchangeability: No
    Diagnosis of Chronic Migraine Required: No
    Required Decrease in Duration of Chronic Migraine for Reauthorization: Unspecified
    Provider Responsibility Language Referenced in Policy: No
    Dose Conversion Language Included in Policy: No
    Reauthorization Criteria Includes 50% Reduction Language: No
    Reauthorization Criteria Includes 7 Day100 Hour Reduction Language: No
    ICHD2ICHD3 Language Included in Policy: chronic migraines occurring at least 15 days in a single month, for at least 3 months
    Retreatment Language Included in Policy: N/A
    Policy Contains ICHD2 or ICHD3 Language: ICHD 3 criteria exist

    Migraine Prevention:
    Duration: 3 Month(s)
    Documented Diagnosis: Yes

<< Return | Back to top