CurrentCignaPolicy N/A

Migraine - Ubrelvy (ubrogepant) Prior Authorization Policy

Defines Cigna's prior authorization requirements for coverage of Ubrelvy (ubrogepant) for the acute treatment of migraine in eligible adults under Cigna-administered health benefit plans.

Policy Summary

PayerCigna

PolicyMigraine - Ubrelvy (ubrogepant) Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and document patient is ≥18 and has tried at least one triptan or has a prescriber-documented contraindication to triptans.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

≥18minimum patient age for approval

≥1required prior triptan trial

1 yrapproval duration

2025-02-26last review

Coverage Criteria for Ubrelvy (ubrogepant)

Migraine, Acute Treatment

Covered when ALL of the following are met

Adult requirement: Patient is ≥ 18 years of age≥ 18 years

Approval condition

Triptan trial or contraindication: Patient has tried at least one triptan therapy OR, according to the prescriber, has a contraindication to triptan(s)at least one triptan trial or documented contraindication
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.

Policy Summary

PayerCigna

PolicyMigraine - Ubrelvy (ubrogepant) Prior Authorization Policy

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization and document patient is ≥18 and has tried at least one triptan or has a prescriber-documented contraindication to triptans.

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.

The policy includes a section titled CONDITIONS NOT COVERED that specifically lists Ubrelvy (ubrogepant tablets - Allergan). While the policy text does not enumerate particular clinical scenarios under this heading, the presence of this list indicates that uses of Ubrelvy which are not explicitly authorized by the coverage criteria are considered not covered. In practice, this means that requests for Ubrelvy lacking documentation that meets the stated coverage requirements (for example, age and triptan trial/contraindication criteria) would be treated as non‑covered and may be denied or require an exception review.

Provider Actions, Authorization & Documentation

Prior Authorization

Prior Authorization Requirement

Prior authorization is required. Approvals are issued for 1 year for patients ≥18 years of age who meet the coverage criteria for acute treatment of migraine with Ubrelvy.

Step Therapy

Step Therapy / Triptan Trial

Step therapy — a trial of at least one triptan is expected before approval unless the prescriber documents a contraindication to triptan therapy.

Affected drugs: triptans (e.g., almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan)

Documentation Required

Required Documentation

Required documentation must be submitted to support the request, including: patient age (to confirm ≥18 years), documentation of trial of at least one triptan (medication name, dose, dates tried, and reason for failure or intolerance), or a prescriber-documented contraindication to triptans. Include any other relevant clinical information supporting the need for Ubrelvy (e.g., history of response to prior acute therapies, reasons standard acute treatments were inadequate).

Denial Risk

Denial Triggers

Denial triggers: requests may be denied if the patient is under 18 years of age, if there is no evidence the patient tried at least one triptan and no prescriber-documented contraindication, or if submitted documentation lacks sufficient clinical detail to establish medical necessity.

OpenPayer

Migraine - Ubrelvy (ubrogepant) Prior Authorization Policy

Coverage Criteria for Ubrelvy (ubrogepant)

Provider Actions, Authorization & Documentation

Definitions

Background