UnitedHealthcare
Lenvima (8 MG Daily Dose) (lenvatinib)
Drugs for Cancer : Drugs for Cancer
  • Quantity Limit: 1 tablet per 1 day(s).
  • Prior Authorization: PA Required
  • Migraine:
    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 Frequency: 4 per month
    Is supporting documentation required for initial approval: Yes
    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