Erenumab-aooe (Aimovig®)

SELF ADMINISTRATION

Indications for Prior Authorization:

  • Preventive treatment of migraine in adults

Patients must meet the following criteria for the indication(s) above:

  • Patient is 18 years of age or older, AND
  • Patient has 4 or more migraine headache days per month (prior to initiating a migraine-preventive medication) as supported by chart note documentation, AND
  • Patient has tried and failed at least 2 standard prophylactic pharmacologic therapies, each from a different pharmacologic class (e.g. angiotensin receptor blocker, angiotensin converting enzyme inhibitor, anticonvulsant, ß-blocker, calcium channel blocker, tricyclic antidepressant, other antidepressant), and meets one of the following:
    • The patient has had inadequate efficacy to both of those standard prophylactic pharmacologic therapies, according to the prescribing physician, OR
    • The patient has experienced adverse event(s) severe enough to warrant discontinuation of both of those standard prophylactic pharmacologic therapies, according to the prescribing physician, OR
    • The patient has had inadequate efficacy to one standard prophylactic pharmacologic therapy and has experienced adverse event(s) severe enough to warrant discontinuation to another standard prophylactic pharmacologic therapy, according to the prescribing physician, AND
  • For patients previously on Botox®: patient has not received a Botox® injection in the past 8 weeks, AND
  • Patient will not be initiaing Botox® injection therapy, AND
  • Patient will not use Aimovig® in combination with another CGRP receptor antagonist (e.g. Emgality® or Ajovy®)

The following conditions do not meet the criteria for use as established by WHA P&T committee:

  • Acute treatment of migraine, cluster headache, hemiplegic migraine
  • Not approvable for concomitant use with Botox®

Dosing:

  • Recommended dose: 70 mg once monthly; some patients may benefit from a dosage of 140 mg once monthly

Approval:

  • Initial: 3 months
  • Renewal: 1 year if chart note documentation denotes a positive clinical response documenting a decrease in the number and frequency of migraine headaches

Last review date: July 23, 2019