Diagnosis: Migraines.
Treatment: Aimovig.
The insurer denied Aimovig.
The determination is upheld.

This is a female patient with chronic migraine who is requesting treatment with Aimovig. The patient had previously tried and failed oral medication such as propranolol, amitriptyline, and riboflavin. The Aimovig was denied because the patient has not used the available formulary alternatives of Emgality, Ajovy, and Qulipta. At issue is whether the formulary drugs will be ineffective, would not be as effective as the non-formulary drug, or would have adverse effects.

There is no documentation to show that the patient has tried and failed the available formulary alternatives of Ajovy, Emgality, or Qulipta. There is no reason to believe that these drugs would not be as effective as the non-formulary drug Aimovig. Although there are no head-to-head comparisons of these medications available, all of the formulary alternatives are Food and Drug Administration (FDA) approved and literature and compendious supported for preventative treatment of migraine. There are no data to show that Aimovig is superior to these drugs. As such, it cannot be said that the formulary alternatives would not be as effective.