Diagnosis: Migraines

Treatment Reyvow

The insurer denied coverage for Reyvow.

The denial is overturned.

The patient has a past medical history of migraines, multiple sclerosis, stroke, gastroesophageal reflux disease, hypercholesterolemia, osteoporosis, and thyroid nodules. The patient was currently utilizing amitriptyline 50 mg (milligram) nightly. The patient denied side effects. The patient was having almost daily headaches. The patient was taking Fioricet and BC powder for the headaches. As per the progress note, the patient took Fioricet about 45 pills/month although she did not take them every day. She is currently on amitriptyline 50mg nightly. The patient had daily headaches and migraines once a week. The associated symptoms included phonophobia, photophobia, and nausea. The patient had tried Emgality. The patient noted the gabapentin and propranolol did not work. The Fioricet helped. The provider recommended Ubrelvy at onset of headache and again 2 hours later if needed. The patient was to stop Fioricet. The patient was not able to take triptans.

The appeal letter noted that the patient has tried and failed all the formulary alternatives. She has tried and failed Nurtec ODT (rimegepant), Ubrelvy (ubrogepant), zembrace symtouch, and zomig nasal spray. She cannot take triptans because of a history of stroke. It should also be noted that she is taking fluoxetine and keppra and trazadone.

In a note, the plan included amitriptyline, Emgality (galcenezumab-gnlm) monthly injections and Ubrelvy for immediate treatment. Patient is to stop Fioricet.

The formulary medications except for Nurtec are likely to cause the patient an adverse reaction. All of the other medications are triptans, which would put her at risk for a stroke. Therefore, all of these formulary meds must be avoided. Nurtec is the only safe alternative on the formulary, and she has already tried and failed Nurtec.

The requested drug Reyvow should be more effective because it has a different mechanism of action and formulation. As stated by Up to Date "Reyvow-Lasmiditan is a selective serotonin 1F (protein receptor) agonist that lacks vasoconstrictor activity and therefore can be used for patients with relative contraindications to triptans due to cardiovascular risk factors."

The insurer's denial of coverage for Formulary Exception for Reyvow is reversed.