CurrentCignaPolicy N/A

Methylergonovine (Methergine) Prior Authorization Policy

Defines prior authorization requirements for prescription methylergonovine (Methergine and generic) under Cigna-administered health benefit plans, including limits for FDA-approved obstetric use and criteria for migraine treatment.

Policy Summary

PayerCigna

PolicyMethylergonovine (Methergine) Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateJul 3, 2024

Key ActionObtain prior authorization for methylergonovine when prescribed for migraine or when quantities exceed 28 tablets per 30 days and document prior trial history and specialist consultation as required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

28automatic sufficient quantity for FDA-approved indication

1 yrauthorization duration for migraine indications

≥18minimum age for migraine approvals

triptan+1required prior failures for acute migraine

≥2required prior prophylactic trials

Policy Summary

PayerCigna

PolicyMethylergonovine (Methergine) Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateJul 3, 2024

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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) Patient meets ONE of the following:
- i. Patient is already receiving methylergonovine therapy.
- ii. Patient meets ALL of the following:
  - a) Patient has tried and had inadequate efficacy and/or unacceptable side effects to at least one triptan therapy.
    Examples of triptans include almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan.
  - b) Patient has tried and had inadequate efficacy and/or unacceptable side effects to at least one other type of abortive therapy.
    Examples of abortive therapies include analgesics (acetaminophen, NSAIDs), butalbital-containing products, dihydroergotamine (DHE), and oral CGRP receptor antagonists (rimegepant, ubrogepant, lasmiditan).
  - c) The medication is prescribed by or in consultation with a neurologist or headache specialist.

Provider Actions

Prior Authorization

Quantity-based prior authorization

Prior Authorization is recommended for prescriptions with quantities exceeding 28 tablets per 30 days. Twenty-eight (28) tablets per 30 days is considered sufficient for the FDA‑approved obstetric indication (uterine atony, hemorrhage, and subinvolution of the uterus following delivery of the placenta); quantities ≤28 tablets per 30 days do not require prior authorization for that indication.

Quantity limit: >28 tablets per 30 days — prior authorization required; ≤28 tablets per 30 days — automatic for FDA obstetric indication.

Prior Authorization

Prior authorization for migraine indications

Prior authorization is required for use of methylergonovine for acute or preventive treatment of migraine. Approvals for migraine (both acute and preventive) are granted for 1 year.

Migraine indications (acute or preventive) — prior authorization required; approvals valid for 1 year.

Step Therapy

Required prior therapy for acute migraine

For approval of methylergonovine for acute migraine, the patient must meet both age and prior‑therapy requirements. Specifically: patient must be ≥18 years of age, and either already be receiving methylergonovine therapy or have tried and had inadequate efficacy and/or unacceptable side effects to at least one triptan AND at least one other abortive therapy. Examples of triptans include almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, and zolmitriptan. Examples of abortive therapies include analgesics (acetaminophen, NSAIDs), butalbital-containing products, dihydroergotamine (DHE), and oral CGRP receptor antagonists (rimegepant, ubrogepant, lasmiditan). The medication must be prescribed by or in consultation with a neurologist or headache specialist.

Acute migraine prior therapy: ≥1 triptan AND ≥1 other abortive therapy (unless already receiving methylergonovine).
Prescriber requirement: prescribed by or in consultation with a neurologist or headache specialist.

Step Therapy

Required prior therapy for migraine prevention

For approval of methylergonovine for migraine prevention, the patient must be ≥18 years of age, have tried at least two standard prophylactic pharmacologic therapies from different pharmacologic classes, and the medication must be prescribed by or in consultation with a neurologist or headache specialist. Examples of prophylactic therapies include angiotensin receptor blockers, ACE inhibitors, anticonvulsants, beta‑blockers, calcium channel blockers, CGRP receptor antagonists indicated for prevention, tricyclic antidepressants, and other antidepressants.

Migraine prevention requirements: ≥2 prophylactic therapies from different classes tried and inadequate; prescriber requirement: neurologist or headache specialist.

Documentation Required

Required documentation

When requesting prior authorization for quantities exceeding 28 tablets per 30 days or for migraine indications, include documentation of the patient’s age, detailed prior trial history (medication names, doses, dates, and reason for discontinuation or inadequate response), indication being treated, and the name or specialty of the prescribing or consulting neurologist/headache specialist. For obstetric FDA‑approved uses, requests >28 tablets per 30 days must include justification for the higher quantity.

Required documentation: patient age; prior trial history with specifics (drug names, dates, outcomes/reasons for discontinuation); indication; prescriber specialty or consultation note (neurologist/headache specialist) when applicable.
Quantity justification required for requests >28 tablets/30 days, including for FDA obstetric indication.

Denial Risk

Non‑covered indications

Use of methylergonovine for any indication not listed as an FDA‑approved indication or other uses with supportive evidence is considered experimental, investigational or unproven and is not covered.

Non‑covered indications — all other uses are experimental/investigational and not covered.

OpenPayer

Methylergonovine (Methergine) Prior Authorization Policy

Coverage Criteria

Coding

Provider Actions

Background

Definitions