CurrentUnitedHealthcarePolicy 2025 P 2188-9

Reyvow (lasmiditan) prior authorization and medical necessity

Defines UnitedHealthcare commercial plan prior authorization and medical necessity criteria for Reyvow (lasmiditan) for acute treatment of migraine in adults, including required prior trials, prescriber attestation, and reauthorization requirements.

Policy Summary

PayerUnitedHealthcare

PolicyReyvow (lasmiditan) prior authorization and medical necessity

Policy CodePolicy 2025 P 2188-9

Change TypeRoutine review — no material changes

Effective DateJun 1, 2025

Next Review DateMar 1, 2025

Key ActionObtain prior authorization and document trials of two triptans and step-through trials of Nurtec ODT and Ubrelvy, plus prescriber attestation about CNS impairment and concurrent CNS depressant assessment.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsauthorization duration

>=18min patient age (yrs)

2prior triptan trials

Nurtec & Ubrelvystep-through agents

positive responsereauthorization

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Coverage Criteria for Reyvow (lasmiditan)

Initial Therapy

Covered when ALL of the following are met unless an OR branch is specified

Initial Authorization

Indication and Age: a) Used for acute treatment of migraine; b) Patient is 18 years of age or older
Prior acute therapy: c) History of therapeutic failure, contraindication, or intolerance after at least 3 migraine episodes and a minimum 30-day trial to two of the following triptans (document name and date tried): almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan
Prescriber attestation: d) Prescriber attests to BOTH: 1) patient has been informed Reyvow may cause significant CNS impairment and may impact ability to drive or operate machinery for 8 hours after each dose; 2) if used concurrently with a benzodiazepine or other CNS depressant, prescriber completed an assessment of increased risk for sedation and other cognitive and/or neuropsychiatric adverse events
Step-through and prophylactic conditions
- Step-through agents: 1) Both Nurtec ODT and Ubrelvy have been tried (step-through)
- Prophylactic therapy OR low-frequency migraine: 2) Patient is currently treated with one of the following prophylactic therapies: a beta-blocker (atenolol, metoprolol, nadolol, propranolol, timolol), candesartan, a CGRP antagonist/inhibitor (e.g., Aimovig, Ajovy, Emgality, Qulipta, Vyepti), divalproex sodium, onabotulinumtoxinA, an SNRI (duloxetine, venlafaxine), topiramate, or a tricyclic antidepressant (amitriptyline, nortriptyline) OR patient has < 4 migraine days per month
- >=4 migraine days alternative: 3) OR patient has >=4 migraine days per month and has contraindication or intolerance to one of the listed prophylactic therapies (same list)

Continuation Therapy

Reauthorization covered when the following is met

Reauthorization: Documentation of positive clinical response to Reyvow therapy is required for reauthorization

Note: Ajovy (fremanezumab) is typically excluded from coverage and is listed as an excluded prophylactic agent in this policy context. Providers should not substitute Ajovy when documenting required prophylactic therapies for Reyvow prior authorization without confirming plan-specific coverage exceptions.

Provider Requirements, Prior Authorization, and Documentation

Prior Authorization

Prior Authorization Required — Approval Criteria

Prior authorization is required for Reyvow (lasmiditan). Approval is conditioned on meeting all clinical requirements listed below: adult patient (≥18 years); drug is for the acute treatment of migraine; documentation of therapeutic failure, contraindication, or intolerance to required acute agents (see step therapy/lower-cost options); and prescriber attestation regarding sedation/drive-risk and assessment when used with CNS depressants.

Reyvow is approved only for adults (≥18 years) for acute migraine.
Documented therapeutic failure, intolerance, or contraindication to required acute agents (see Step Therapy callout) after at least 3 migraine episodes and ≥30 days trial where applicable.
Prescriber must attest that patient was informed Reyvow may impair driving/operation of machinery for at least 8 hours after each dose and that risks were assessed if used with benzodiazepines or other CNS depressants.
Documentation must include drug names and dates tried.

Step Therapy

Step Therapy — Lower‑Cost Alternatives Required

Definitions and Indications

inv-09: Indication

IndicationAcute treatment of migraine

Patient population>= 18 years of age (adults)

Drug classSerotonin 5-HT1F receptor agonist (lasmiditan)

Safety noteMay cause significant CNS impairment; advise patients not to drive or operate machinery for at least 8 hours after each dose

Coverage contextPrior authorization required with documented prior therapy and step requirements per policy

Background

Reyvow (lasmiditan) is a serotonin 5-HT1F receptor agonist indicated for the acute treatment of migraine with or without aura in adults.

Safety note: Reyvow may cause significant CNS impairment after dosing. Patients should be counseled that use can affect their ability to drive or operate machinery for up to 8 hours following a dose, and prescribers must attest that they have discussed this risk and assessed the increased sedation/cognitive risk if Reyvow is used with benzodiazepines or other CNS depressants.

Documentation Required

Required Documentation and Triggers for Denial

Common documentation required at time of PA submission to support medical necessity and avoid denial: include patient age, indication (acute migraine), detailed trial history with drug names and dates, reason for failure/intolerance/contraindication for each agent not tried, and prescriber attestation regarding CNS impairment and co‑administration assessment.

Document trials of two triptans (names and dates) or reasons for inability to trial them (see list of acceptable triptans).
Document trials (with dates) of Nurtec ODT and Ubrelvy or clinical justification for not using these agents.
If patient has ≥4 migraine days/month and is not currently on preventive therapy, document contraindication/intolerance to at least one listed preventive agent or document current preventive therapy.
Include explicit prescriber attestation that patient was informed of 8‑hour driving/alertness risk and that risks were assessed if combined with benzodiazepines or other CNS depressants.