Cigna + Oscar
Emgality (300 MG Dose) (galcanezumab-gnlm)
Drugs for the Nervous System : Drugs for Migraine Headaches
  • Step Therapy: Cluster Headache:
    ST Single Generic

    Migraine Prevention:
    ST Multiple Generics

  • Cluster Headache:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Medical Test Required: No
    Specialist Type(s): 1 of Headache Specialist;Neurologist;Pain Management Specialist
    Reauthorization Required: Yes
    Duration of Reauthorization: = 12 month(s)

    Migraine Prevention:
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Specialist Required: Yes
    Documented Diagnosis: Yes
    Specialist Type(s): 1 of Headache Specialist;Neurologist;Pain Management Specialist

  • PA_APPLIES
  • Prior Authorization: Cluster Headache:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)
    Reauthorization Required: Yes

    Migraine Prevention:
    Documented Diagnosis: Yes
    Age Requirement: >= 18
    Duration: 6 Month(s)

  • Quantity Limit: limit maximum 1 ML PER 23 day(s)
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