Diagnosis: Chronic Migraines (w/o aura)
Treatment: Formulary exception for Ubrelvy (ubrogepant)
The insurer denied the Formulary exception for Ubrelvy (ubrogepant)
The denial is overturned.

The patient is a female with migraine headache disorder. She has tried and failed rizatriptan, frovatriptan, zolmitriptan, naratriptan, and sumatriptan for abortive therapy. Her provider is requesting Ubrelvy.

Yes, the health plan should cover the formulary exception for Ubrelvy.
The provider has indicated in an appeal letter that the patient has tried and failed five preferred formulary triptans (Thorlund et al.). This is sufficient to conclude that she is unlikely to response to this class of medications, and further trials would likely be futile. Ubrelvy is FDA (United States Food and Drug Administration)-indicated for the patient's condition (Dodick et al.) and a trial in this clinical context would be considered standard of care and appropriate.