Diagnosis: Migraines
Treatment: Ubrelvy (ubrogepant), Pre-service
The insurer denied the Ubrelvy (ubrogepant).
The denial is upheld.

The patient is an adult female who has migraine headache disorder. She has tried and failed sumatriptan and rizatriptan. The provider indicated an allergy to triptans, but details of the allergy are not documented. The provider is requesting Ubrelvy. However, the request is being denied coverage because the insurer requires failure of three preferred medications.

No. The health plan should not cover the requested Ubrelvy.

There is no reason the patient cannot be treated with the preferred formulary triptans. The provider indicated an allergy to triptans, but she has then tried two triptans (rizatriptan, sumatriptan) and the adverse effect is not documented to preclude the use of additional preferred agents. Triptans are FDA (Food Drug Administration) approved for acute treatment of migraine headaches and are considered first line, standard of care, abortive agents (Thorlund et al., 2017). There are no high quality clinical trials or standard of care guidelines supporting the preferential use or superiority of Ubrelvy relative to the preferred agents. As such, the request for Ubrelvy should not be covered at this time.