CurrentCignaPolicy N/A

Migraine - Reyvow Prior Authorization Policy

Cigna prior authorization policy for Reyvow (lasmiditan tablets) for acute treatment of migraine in adults; defines medical necessity criteria, coverage duration, contraindication examples, and that other uses are investigational.

Policy Summary

PayerCigna

PolicyMigraine - Reyvow Prior Authorization Policy

Policy CodePolicy N/A

Change TypeAnnual review — no criteria changes

Effective Date

Next Review Date

Key ActionPrior Authorization is recommended for Reyvow; approve for 1 year when criteria are met and document trial of at least one triptan or a prescriber-stated contraindication.

POLICY UPDATE CHANGES

Annual review completed with no criteria changes noted as of 08/07/2024.

1Covered Indication (acute migraine)

1 yearInitial Approval Duration

≥18Minimum Age

Coverage Summary

Scope: Cigna prior authorization policy for Reyvow (lasmiditan tablets) for acute treatment of migraine in adults; defines medical necessity criteria, coverage duration, contraindication examples, and that other uses are investigational.

Coverage stance: Covered with criteria — prior authorization is recommended and approvals are provided when criteria are met.

Initial Therapy Criteria (FDA-Approved Indication)

FDA-Approved Indication: Migraine, Acute Treatment

Approve for 1 year if the patient meets BOTH of the following (A and B):

ALL of the following

A
- Patient is ≥ 18 years of age
B
- i: Patient has tried at least one triptan therapy
- ii: Patient has a contraindication to triptan(s) according to the prescriber
  Examples of contraindications include history of coronary artery disease; cardiac accessory conduction pathway disorders; history of stroke, transient ischemic attack, or hemiplegic or basilar migraine; peripheral vascular disease; ischemic bowel disease; uncontrolled hypertension; or severe hepatic impairment.

Unproven Uses and Exclusions

Conditions Not Covered

Reyvow is considered experimental, investigational, or unproven for:

ALL of the following

ANY other use(s) beyond the FDA-approved acute treatment of migraine in adults

Provider Actions

Prior Authorization

Prior authorization required

Prior Authorization is recommended for prescription benefit coverage of Reyvow; approvals provided for 1 year when criteria are met.

Documentation Required

Document trial or contraindication to triptans

Provider must document trial of at least one triptan therapy or document a prescriber-stated contraindication to triptans (examples provided in policy).

Examples of contraindications: history of coronary artery disease; cardiac accessory conduction pathway disorders; history of stroke, TIA, hemiplegic or basilar migraine; peripheral vascular disease; ischemic bowel disease; uncontrolled hypertension; severe hepatic impairment.

Clinical Evidence & References

Evidence entries:

• Prescribing information: Reyvow tablets [prescribing information], Lilly; September 2022.

• Guideline summary: American Headache Society lists Reyvow as effective for acute migraine (AHS 2018, updated 2021).

Note: Triptans and other acute therapies (e.g., dihydroergotamine, oral gepants such as rimegepant and ubrogepant) are guideline-recommended alternatives for acute migraine treatment.

Background & Definitions

Reyvow (lasmiditan) is a 5-HT1F receptor agonist indicated for the acute treatment of migraine with or without aura in adults. The drug is not indicated for migraine prevention.

Guideline context: The American Headache Society (2018; updated 2021) lists Reyvow among effective treatments for moderate or severe acute migraine attacks and for mild to moderate attacks that respond poorly to nonprescription analgesics.

Alternatives: Triptans (e.g., almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan) and other acute therapies (dihydroergotamine, oral gepants such as rimegepant and ubrogepant) are guideline-recommended alternatives; prescribers should consider efficacy and potential adverse events when selecting acute migraine medications.

Term	Definition
Chronic migraine	Headache occurring on ≥ 15 days/month for >3 months with features of migraine on ≥ 8 days/month.
Episodic migraine	Headaches that occur < 15 days/month.