Diagnosis: Hemiplegic migraine.
Treatment: Formulary Exception for Ubrelvy (ubrogepant).

The insurer denied coverage for Formulary Exception for Ubrelvy (ubrogepant).

The denial is overturned.

This is a female patient with a history of headaches with complicated migraine.
The patient has hemiplegic migraine. Her Neurologist prescribed Ubrelvy.

The insurer denied Ubrelvy and instead recommended formulary alternatives including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan injection, sumatriptan nasal spray, sumatriptan tablet, zolmitriptan, Nurtec oral disintegrating tablet (ODT), Zembrace SymTouch, Zomig nasal spray (trial and failure of no more than three). These are all triptans and are contraindicated.

As noted above the patient has hemiplegic migraines. This puts her at increased risk of stroke, especially if she takes a triptan.

The requested medication is likely to produce a more clinically beneficial outcome to the patient.

The insurer's denial of coverage for Formulary Exception for Ubrelvy (ubrogepant) is overturned.