CurrentUnitedHealthcarePolicy N/A

Step therapy for Reyvow (lasmiditan)

Defines prior authorization step therapy requirements for coverage of Reyvow (lasmiditan) for acute treatment of migraine in adults, applicable to UnitedHealthcare members governed by this program.

Policy Summary

PayerUnitedHealthcare

PolicyStep therapy for Reyvow (lasmiditan)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2025

Next Review DateMar 1, 2025

Key ActionObtain prior authorization documenting failure, intolerance, or contraindication to two oral triptans and both Nurtec ODT and Ubrelvy with dates and trial durations.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

12 monthsauthorization duration

>=3required prior therapeutic trial episodes

>=30 daysminimum trial length

2 triptans + Nurtec + Ubrelvyrequired prior therapies

Step Therapyprogram

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Reyvow will be approved when ALL of the following are met:

ALL of the following

History of a therapeutic failure (after at least 3 migraine episodes and a minimum of a 30-day trial), contraindication, or intolerance to the required acute migraine therapies. Document medication name(s) and date(s) tried.
a.
- Trial, contraindication, or intolerance to TWO of the following triptans: almotriptan (Axert); eletriptan (Relpax); frovatriptan (Frova); naratriptan (Amerge); rizatriptan (Maxalt/Maxalt MLT); sumatriptan (Imitrex); zolmitriptan (Zomig/Zomig-ZMT).
b.
- Trial, contraindication, or intolerance to BOTH of the following medications: Nurtec ODT and Ubrelvy.
Authorization will be issued for 12 months.

State mandates, federal regulatory requirements, and member-specific benefit plan coverage may impact coverage; supply limits and additional restrictions may apply.

Additional clinical programs and controls that may apply include: supply limits; Prior Authorization - Medical Necessity; Prior Authorization - Notification. UnitedHealthcare may approve initial and reauthorization requests based on previous claim/medication history, diagnosis codes (ICD-10), and/or claim logic; use of automated approval and re-approval processes varies by program and therapeutic class.

Provider Actions / Prior Authorization Requirements

Step Therapy

Step therapy requirement — Reyvow

Step therapy program: Reyvow (lasmiditan) is subject to step therapy requiring trials of lower-cost/formulary alternatives prior to approval.

Program type: Step Therapy — trials of preferred/alternative therapies required before Reyvow
Required prior therapies to document (name and date tried for each): two oral triptans from the listed options AND both Nurtec ODT and Ubrelvy
Required trial duration: at least 30 days and occurrence during at least 3 migraine episodes (document duration and outcome)
Documentation must include tolerability or specific contraindication/intolerance if therapy not tried
Failure to meet step-therapy requirements may result in denial of coverage

Documentation Required

Prior Authorization & Required Documentation

Prior authorization is required. Providers must document therapeutic failure (or contraindication/intolerance) to the required agents with dates and trial duration. Authorization, if approved, will be issued for 12 months.

Prior authorization: document name and date tried for each prior therapy
Required triptan trials (any two): almotriptan (Axert); eletriptan (Relpax); frovatriptan (Frova); naratriptan (Amerge); rizatriptan (Maxalt/Maxalt MLT); sumatriptan (Imitrex); zolmitriptan (Zomig/Zomig-ZMT)
Required CGRP/ditan alternatives: Nurtec ODT and Ubrelvy (both must be tried unless contraindicated/intolerant)
Operational note: State mandates and member benefit plan may affect coverage

Denial Risk

Failure to meet step-therapy requirements — Denial risk

Coverage may be denied if the member has not documented therapeutic failure after the required episodes and trial durations, or if required prior therapies are not adequately documented (including dates, duration, and reason for discontinuation).

Denial risk: missing or incomplete documentation of prior trials (names, dates, durations, outcomes) may lead to denial
Denial risk: failure to demonstrate ≥30-day trial and occurrence across ≥3 migraine episodes for each listed prior therapy

Initial Prior Therapy Requirements

Initial prior therapy requirements

Initial therapy requirements before Reyvow coverage:

Required prior therapies

Oral triptans (choose at least 2): almotriptan; eletriptan; frovatriptan; naratriptan; rizatriptan; sumatriptan; zolmitriptan.>= 2 agents
Document agent names and dates tried.
Gepants: Nurtec ODT AND Ubrelvy must be tried or have documented contraindication/intolerance.both
Document agent names and dates tried.

Step Therapy Details

Step	Required prior therapies before Reyvow	Notes
1	Trial, contraindication, or intolerance to at least two oral triptans from the following: almotriptan (Axert); eletriptan (Relpax); frovatriptan (Frova); naratriptan (Amerge); rizatriptan (Maxalt/Maxalt MLT); sumatriptan (Imitrex); zolmitriptan (Zomig/Zomig-ZMT)	>= 3 migraine episodes and minimum 30-day trial for each therapy; provider must document name and date tried and reason for failure/intolerance/contraindication
2	Trial, contraindication, or intolerance to both Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant)	Both agents must be tried unless contraindicated or intolerant; authorization issued for 12 months

Policy Summary

PayerUnitedHealthcare

PolicyStep therapy for Reyvow (lasmiditan)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJun 1, 2025

Next Review DateMar 1, 2025

Key ActionObtain prior authorization documenting failure, intolerance, or contraindication to two oral triptans and both Nurtec ODT and Ubrelvy with dates and trial durations.

SourceLink

On This Page

OpenPayer

Step therapy for Reyvow (lasmiditan)

Coverage Criteria

Coding & Required Episodes

Provider Actions / Prior Authorization Requirements

Initial Prior Therapy Requirements

Reauthorization / Continuation Criteria

Step Therapy Details

Quantity Limits

Definitions

Background