Prior Authorization/Medical Necessity - Nurtec ODT (rimegepant), Qulipta (atogepant), Ubrelvy (ubrogepant), Zavzpret (zavegepant)
Defines prior authorization and medical necessity criteria for Nurtec ODT (rimegepant), Qulipta (atogepant), Ubrelvy (ubrogepant) and Zavzpret (zavegepant) for acute and preventive migraine treatment, including initial and reauthorization requirements, contraindications/intolerance/step therapy expectations, coverage duration, and program-specific notes and state exceptions.
Effective 5/1/2025 program in place; multiple prior revisions recorded from 3/2020 through 2/2025 reflecting iterative updates to triptan requirements, CGRP steps, inclusion of Zavzpret, Qulipta criteria updates, and state-specific footnotes.
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.