Diagnosis: Migraine headache disorder
Treatment: Emgality Injection 120 (mg) - Quantity 1 for 30 Days (Pre-service)
The insurer denied the Emgality Injection 120 (mg) - Quantity 1 for 30 Days (Pre-service).
The denial is upheld.

The patient is a female with migraine headache disorder. She has tried topiramate, propranolol and zonisamide for migraine prevention. The attending physician (AP) is requesting Emgality.

No, the proposed treatment with Emgality is not medically necessary.

Treatment with Emgality at this time would not be in accordance with generally accepted standards of medical practice. Standard of care guidelines support adequate trials of oral migraine preventive agents prior to the use of calcitonin gene-related peptide (CGRP) inhibitors. The documentation does not support an adequate trial duration of any oral migraine preventive agent (Schwedt).

There is no reason the patient cannot be treated with an adequate trial of standard, oral migraine preventive agents prior to the use of calcitonin gene-related peptide (CGRP) inhibitors. The documentation does not support an adequate trial duration of any oral migraine preventive agent (Schwedt).