Diagnosis: Migraines
Treatment: Qulipta 60 mg (milligrams) tablet
The insurer denied the Quilipta 60 mg tablet.
The determination is upheld.

The patient is a female with a history of migraines. She was prescribed the drug Qulipta for treatment. The drug was denied because the patient has not tried and failed Ajovy, Aimovig, and Emgality. The provider appealed the determination.

At issue is the coverage for the non-formulary drug, Qulipta.

The health plan's determination is upheld in whole.

There is no reason that Ajovy, Emgality, or Aimovig would not be effective for prevention of migraine. There is no documentation that the patient has previously tried and failed these medications. Ajovy, Aimovig, and Emgality are Food and Drug Administration (FDA) approved for prevention of episodic and chronic migraine. These medications have been shown to decrease migraine frequency by approximately 50 percent (%). There is no comparative data available to suggest that Qulipta is more effective than Ajovy, Aimovig, or Emgality.