Triptans (Revised)

Billing and prior authorization team must: (1) Implement step therapy verification in claims processing system to confirm members have trial history with at least TWO of the following generic products before approving coverage for other triptans: sumatriptan, rizatriptan, or naratriptan; (2) When requesting prior authorization for any triptan product listed in this policy (almotriptan, eletriptan, Frova, frovatriptan, Onzetra Xsail, Relpax, RizaFilm, sumatriptan-naproxen, Symbravo, Tosymra, Treximet, Zembrace Symtouch, zolmitriptan, zolmitriptan nasal spray, Zomig, or Zomig nasal spray), require documentation of prior trial with TWO generic triptans; (3) Update prior authorization request forms and provider communication templates to reflect the two-generic-trial requirement; (4) Train billing and PA staff on the step therapy criteria and contraindication screening (CAD, stroke history, uncontrolled hypertension, etc.); (5) Flag claims for Humana Medicare Advantage members requesting non-generic triptans that lack documented two-generic-trial history for denial or PA request. Failure to implement step therapy verification will result in claim denials and patient complaints. This policy supersedes any previous triptan coverage guidance and is effective immediately given the recent revision date.