CurrentCignaPolicy IP0573

Migraine - Zavzpret

Defines Cigna's prior authorization and coverage criteria for Zavzpret for the acute treatment of migraine in adults, including plan-specific step therapy and contraindication exceptions.

Policy Summary

PayerCigna

PolicyMigraine - Zavzpret

Policy CodePolicy IP0573

Change TypeMaterial revisions to title and step therapy criteria

Effective DateFeb 1, 2026

Next Review Date

Key ActionSubmit prior authorization with documentation of prior treatment attempts or contraindications; approvals are provided for 1 year when criteria are met.

SourceLink

POLICY UPDATE CHANGES

Updated coverage policy title from Zavegepant to Migraine - Zavzpret and removed reauthorization criteria.

Relocated triptan prerequisite requirements to preferred product boxes and added steps through Nurtec ODT and Ubrelvy to Standard/Performance plans.

Removed concurrent use of two CGRP inhibitors as a condition not covered.

≥18minimum patient age for approval

1 yrinitial approval duration

PA requiredauthorization requirement

Not for preventionlimitation of use

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Coverage Criteria for Zavzpret (zavegepant)

Initial Authorization Criteria

Covered when ALL of the following are met

Age: Patient is ≥ 18 years of age.

Approval for 1 year if criteria met

Indication: Diagnosis: acute treatment of migraine headache with or without aura in adults.

Not indicated for preventive treatment of migraine.

Preferred product criteria (Standard/Performance Employer Plans): Patient meets ONE of the following: (i) tried and experienced inadequate efficacy or significant intolerance to BOTH Nurtec ODT AND Ubrelvy; OR (ii) unable to swallow or has difficulty swallowing tablets and tried and experienced inadequate efficacy or significant intolerance to Nurtec ODT.

Must also meet triptan prerequisite in the next node.

Triptan prerequisite (Standard/Performance Employer Plans): Patient meets ONE of the following: (i) tried and experienced inadequate efficacy or significant intolerance to TWO triptan products (examples listed in policy) OR tried and experienced inadequate efficacy or significant intolerance to one triptan/NSAID combination product or a triptan taken concomitantly with an NSAID; OR (ii) per the prescriber, the patient has a contraindication to triptans OR per the prescriber, the patient has had a significant intolerance to one or more triptans.

Examples of triptan agents and contraindications are provided in policy (e.g., almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan; contraindications include 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).

Value/Advantage/Total Savings/Legacy Plans alternative: Patient meets ONE of the following: (A) has tried at least one triptan product OR has tried and experienced inadequate efficacy or significant intolerance to one triptan/NSAID combination product or a triptan taken with an NSAID; OR (B) per the prescriber, the patient has a contraindication to triptans OR has had a significant intolerance to one or more triptans.

Plan-specific variation less stringent than Standard/Performance.

Individual and Family Plans: Patient meets BOTH of the following: A) Patient meets ONE of: (i) tried and experienced inadequate efficacy or significant intolerance to BOTH Nurtec ODT AND Ubrelvy; OR (ii) unable to swallow or has difficulty swallowing tablets and tried and experienced inadequate efficacy or significant intolerance to Nurtec ODT; AND B) Patient meets ONE of: (i) tried and experienced inadequate efficacy or significant intolerance to TWO triptan products OR tried and experienced inadequate efficacy or significant intolerance to ONE triptan/NSAID combination product or a triptan taken concomitantly with an NSAID; OR (ii) per the prescriber, the patient has a contraindication to triptans OR has had a significant intolerance to one or more triptans.

Examples of triptans and contraindications provided in policy.

Zavzpret for any other use is considered not medically necessary. This policy will be updated if new published data change the coverage stance.

Use of Zavzpret for preventive treatment of migraine or any other non‑acute indication is considered not medically necessary. Zavzpret is indicated for the acute treatment of migraine in adults and is not labeled for migraine prevention.

Billing and Coding

Covered/Referenced Codesmixed

NDC/HCPCS not specified

No specific billing codes listed in policy document

Chronic migraine diagnostic threshold — inv-05: Chronic migraine diagnostic threshold — ≥ 15 headache days/month for >3 months with migraine features on ≥ 8 days/month

Diagnostic threshold≥ 15 headache days per month for > 3 months with migraine features on ≥ 8 days per month

Duration requirementGreater than 3 months of headaches at the specified frequency

Migraine-featured daysAt least 8 days per month with migraine features (e.g., unilateral throbbing pain, photophobia, phonophobia, nausea)

Distinguishes chronic vs episodicChronic migraine: ≥15 days/month; Episodic migraine: <15 days/month

Provider Requirements and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior Authorization is required for prescription benefit coverage of Zavzpret. Approvals are provided for 1 year when criteria are met. Providers must submit documentation supporting prior treatment attempts, intolerances, or contraindications as described in the plan-specific criteria.

Approvals granted for 1 year when all PA criteria are met.
Submit clinical documentation of prior trials, responses, intolerances, or contraindications per the plan-specific step requirements.
When billing, use the most appropriate covered diagnosis and procedure codes as of the date of submission.

Step Therapy

Plan-Specific Step Therapy Requirements

Step therapy and required prior medication trials vary by plan type. Confirm the patient meets the specific plan's step requirements before submitting a prior authorization request.

Standard/Performance Drug List Plans (Employer; Individual & Family): Trial of BOTH Nurtec ODT AND Ubrelvy required, or inability to swallow tablets with documented trial/intolerance to Nurtec ODT.

Background

Zavzpret (zavegepant) is a calcitonin gene‑related peptide (CGRP) receptor antagonist approved for the acute treatment of migraine headache with or without aura in adults. It is not indicated for migraine prevention; the policy therefore limits use to acute treatment scenarios in patients meeting the authorization criteria.

Definitions

Chronic migraine definition — inv-11: Chronic migraine definition — headache occurring on ≥ 15 days/month for more than 3 months with migraine features on ≥ 8 days/month

DefinitionHeadache occurring on ≥ 15 days/month for more than 3 months with migraine features on ≥ 8 days/month

SourceInternational Headache Society description as cited in policy Disease Overview

Clinical implicationMeets threshold for chronic migraine rather than episodic migraine

Example contrastEpisodic migraine is characterized by headaches that occur < 15 days/month