Migraine headaches are an intrusive part of life for many. They affect approximately 18% of women and 6% of men, who experience about one or two migraines per month on average.1 In addition to pain, migraines can be associated with nausea, vomiting, and/or sensitivity to light or sound. Sufferers have reason for encouragement though. The United States Food and Drug Administration (FDA) recently approved three new drugs (Nurtec™ ODT, Reyvow™, and Ubrelvy™) for the acute treatment of migraine headaches and one new drug for the prevention of migraine headaches (Vyepti™).
Reyvow is the first drug in a new class called “ditans” and is a controlled substance schedule V. Nurtec and Ubrelvy are the first oral calcitonin gene-related peptide (CGRP) inhibitors. Vyepti is the fourth CGRP inhibitor for prevention, but it is the first administered intravenously.
The average wholesale price (AWP) for a dose of Reyvow equals $96, while Nurtec ODT equals $127.50, and Ubrelvy equals $102.2 The FDA recommends treating no more than four migraines per month with Reyvow, 15 migraines per month with Nurtec ODT, and eight migraines per month with Ubrelvy. For Vyepti, The AWP for each infusion given quarterly is $1,794 to $5,328, depending on the dose administered or an annual AWP of $7,176 to $21,528.2
Vyepti is a specialty treatment, covered under the medical benefit with prior authorization. Reyvow, Nurtec ODT and Ubrelvy are all currently excluded from formulary coverage. If medical necessity criteria are met, coverage will be available under the pharmacy benefit as a non-preferred brand. Ubrelvy and Nurtec ODT will be added to the formulary as preferred brands on July 1, 2020. Both will be subject to prior authorization and quantity limits. Effective August 1, 2020, Reyvow will be non-formulary or non-preferred brand, depending on the prescription drug list selected with prior authorization and quantity limits.
State laws in Texas and Louisiana may require your plan to cover your medication at your current benefit level until your plan renews. This means that if your medication is taken off the drug list, is moved to a higher cost-share tier or needs approval from Cigna before your plan will cover it, these changes may not begin until your plan’s renewal date. To find out if these state laws apply to your plan, please call customer service using the number on your Cigna ID card.
State law in Illinois may require your plan to cover your medications at your current benefit level until your plan renews. This means that if you currently have approval through a review process for your plan to cover your medication, the drug list change(s) listed here may not affect you until your plan renewal date. If you don’t currently have approval through a coverage review process, you may continue to receive coverage at your current benefit level if your doctor requests it. To find out if this state law applies to your plan, please call customer service using the number on your Cigna ID card.
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