Commercial Plan Formularies
Find detailed information on commercial health plan formularies and prior authorization requirements for CGRP-targeting migraine treatments. Learn about step therapy criteria, quantity limits, and plan-specific policies to guide your coverage decisions across different insurers.
PBM formulary criteria shown are representative of Utilization Management offered. Variations in the prior authorization may occur.
Formulary Name | Acute/Preventive | Step CriteriaDrug search by insurance plan and PBM | Prior Authorization
| Quantity Limits |
|---|---|---|---|---|
| Payers may require treatment trial, contraindication, or intolerance of different classes | Payers may have varying requirements for patients. Upon PA approval, reauthorization may be required after 12 months. | Payers may allow only a set amount of usage over a predefined time period. | ||
| Aetna Standard Plan | Acute | Step x 2: Aetna Formulary migraine products search | Aetna CGRP Gepants Policy Bulletin | Yes |
| 2025 Aetna Standard Plan Drug Guide | Preventive | No steps.
| Aetna Better Health CGRP mAbs prior authorization | Yes |
| Anthem Commercial Formularies | All | Step x 2 | Yes | Yes |
| Cigna Commercial Formularies | Acute | Step x 1 or 2 (depending on plan) | Yes | Yes |
| - | Preventive | No steps | Yes | Yes |
| CVS Caremark PDL – Standard Control | Acute | No Steps | Yes | Yes |
| Preventive | No Steps | Yes | Yes | |
| Express Scripts National Preferred Formulary | Acute | Step x 1 or 2 depending on plan | Yes | Yes |
| Express Scripts Prior Authorization and Step Therapy Policies Search Tool | Preventive | Zero Steps | Yes | Yes |
| Kaiser Northern California | All | Kaiser North CA Commercial Formulary | Yes | Yes |
| Kaiser Southern California | All | Yes | Yes | |
| Prime Therapeutics Commercial Formularies | Acute | Step x1 | Yes | Yes |
| - | Preventive | Step x1 | Yes | Yes |
| Tricare | All | Yes | Yes | |
| United Healthcare Commercial Plans | Acute | Step x2 | Yes | Yes |
| UHC Pharmacy Benefit Formulary Search | Preventive | Step x2
| Yes | Yes |
| VHA Veterans Health Administration | Acute | Yes | Yes | |
| VHA Veterans Health Administration | Acute | Yes | Yes | |
| Preventive |
| Yes | Yes | |
| Other | Yes | Yes |