*MIGRAINE PRODUCTS* – Exemplar Health Benefits Administrator

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

Erenumab-aooe

Tier: 2

PA Type: PA Applies

PA Group: CGRP antagonist class

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

Erenumab-aooe

Tier: 2

PA Type: PA Applies

PA Group: CGRP antagonist class

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

Fremanezumab-vfrm

Tier: Non-Formulary

PA Type: PA Applies

PA Group: CGRP antagonist class

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

Fremanezumab-vfrm

Tier: Non-Formulary

PA Type: PA Applies

PA Group: CGRP antagonist class

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

Tier: 1

PA Type: No Prior Authorization

ST: Y

Almotriptan Malate Tablet 12.5 MG Oral

Tier: 1

PA Type: No Prior Authorization

ST: Y

Almotriptan Malate Tablet 12.5 MG Oral

Tier: 1

PA Type: No Prior Authorization

ST: Y