All *MIGRAINE PRODUCTS*

Aimovig (140 MG Dose) Solution Auto-Injector 70 MG/ML Subcutaneous
Aimovig (140 MG Dose) Solution Auto-Injector 70 MG/ML Subcutaneous

Erenumab-aooe

Tier: 2
PA Type: PA Applies
PA Group: CGRP antagonist class
Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous
Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous

Erenumab-aooe

Tier: 2
PA Type: PA Applies
PA Group: CGRP antagonist class
Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous
Aimovig Solution Auto-Injector 140 MG/ML Subcutaneous

Erenumab-aooe

Tier: 2
PA Type: PA Applies
PA Group: CGRP antagonist class
Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous
Aimovig Solution Auto-Injector 70 MG/ML Subcutaneous

Erenumab-aooe

Tier: 2
PA Type: PA Applies
PA Group: CGRP antagonist class
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous

Fremanezumab-vfrm

Tier: Non-Formulary
PA Type: PA Applies
PA Group: CGRP antagonist class
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous

Fremanezumab-vfrm

Tier: Non-Formulary
PA Type: PA Applies
PA Group: CGRP antagonist class
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous
Ajovy Solution Auto-Injector 225 MG/1.5ML Subcutaneous

Fremanezumab-vfrm

Tier: Non-Formulary
PA Type: PA Applies
PA Group: CGRP antagonist class
Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous
Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous

Fremanezumab-vfrm

Tier: Non-Formulary
PA Type: PA Applies
PA Group: CGRP antagonist class
Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous
Ajovy Solution Prefilled Syringe 225 MG/1.5ML Subcutaneous

Fremanezumab-vfrm

Tier: Non-Formulary
PA Type: PA Applies
PA Group: CGRP antagonist class
Almotriptan Malate Tablet 12.5 MG Oral
Almotriptan Malate Tablet 12.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y
Almotriptan Malate Tablet 12.5 MG Oral
Almotriptan Malate Tablet 12.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y
Almotriptan Malate Tablet 12.5 MG Oral
Almotriptan Malate Tablet 12.5 MG Oral

Tier: 1
PA Type: No Prior Authorization
ST: Y