Aetna
AetnaHome Help Search Contact Us
Aetna TitleSkip the section navigation barAlphabetical ViewWhat's NewAbout Pharmacy Clinical Policy Bulletins
 
    Document Utilities
Print this page
Home  >  Clinical Policy Bulletins  >  Pharmacy  >  Anti-Migraine Agents, “Triptans”
 

Pharmacy Clinical Policy Bulletins

Subject: Anti-Migraine Agents, “Triptans”

Class Edit Summary*
Status Drug PR PR-QL PR-AL ST M EX‡
P Amerge® (naratriptan)   X      
P Imitrex® (sumatriptan)   X      
P Maxalt®, Maxalt MLT® (rizatriptan)   X      
FE Axert® (almotriptan)   X     X
FE Frova® (frovatriptan)   X     X
FE Relpax® (eletriptan)   X     X
FE Zomig®, Zomig ZMT® (zolmitriptan)   X     X

*P = Preferred; FE = Formulary Excluded; NP = Nonpreferred PR = Precertification; QL = Quantity Limits; AL = Age Limits; ST = Step-Therapy ‡M EX = Medical Exception - This means the physician or health care professional must obtain a medical exception from Aetna, in order for the medication to be eligible for coverage. Medical Exception criteria apply to Formulary Excluded drugs for members enrolled in or covered by closed benefits plans, and also apply to Step-Therapy drugs in cases where a member's physician believes it is medically necessary for the member to use a step-therapy drug in the first instance without a trial of the prerequisite alternative drug(s).

Important Note

This Pharmacy Clinical Policy Bulletin expresses Aetna's determination of whether certain services or supplies are medically necessary. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information. Each benefits plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their health care providers will need to consult the member's benefits plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (that is, will be paid for by Aetna) for a particular member. The member's benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a state, the federal government or CMS for Medicare and Medicaid members. CMS's Coverage Database can be found on the following website: http://www.cms.hhs.gov/center/coverage.asp.

Policy

  1. Precertification Criteria

    Under some plans, including plans that use an open or closed formulary, Amerge, Axert, Frova, Imitrex, Maxalt/Maxalt MLT, Relpax, and Zomig/Zomig ZMT are subject to pecertification. If pecertification requirements apply Aetna considers Amerge, Axert, Frova, Imitrex, Maxalt/Maxalt MLT, Relpax, or Zomig/Zomig ZMT to be medically necessary for those members who meet the following precertification criteria:

      A. Quantity limits:

    According to the manufacturer, the safety of treating an average of more than the number of headaches listed below in a 30-day period has not been established. Clinical guidelines recommend two treatment days per week for abortive therapy. A quantity of each drug will be considered medically necessary as indicated in the table below.

    Drug Maximum Number of Headaches/ 30 days Dosage Strength Quantity Limits
    Amerge Up to 4 headaches 1 mg, 2.5 mg Up to 9 tablets in 30 days
    Axert Up to 4 headaches 6.25mg, 12.5mg Up to 6 tablets in 30 days
    Frova Up to 4 headaches 2.5 mg Up to 9 tablets in 30 days
    Imitrex Up to 4 headaches 25mg, 50mg, 100mg Up to 18 tablets in 30 days
    Imitrex Up to 4 headaches Nasal spray Up to 6 sprays in 30 days
    Imitrex Up to 4 headaches Injection kits Up to 4 kits (8 syringes) in 30 days
    Imitrex Up to 4 headaches Injection, 6mg/0.5ml vials Up to 10 vials (5ml) in 30 days
    Imitrex Up to 4 headaches Injection, 4mg/0.5mg syringes Up to 8 syringes in 30 days
    Maxalt, Maxalt MLT Up to 4 headaches 5 mg, 10 mg Up to 12 tablets in 30 days
    Relpax Up to 3 headaches 20 mg Up to 12 tablets in 30 days
    Relpax Up to 3 headaches 40 mg Up to 6 tablets in 30 days
    Zomig, Zomig ZMT Up to 3 headaches 2.5 mg Up to 12 tablets in 30 days
    Zomig, Zomig ZMT Up to 3 headaches 5 mg Up to 6 tablets in 30 days
    Zomig Up to 3 headaches Nasal spray Up to 6 sprays in 30 days

    For coverage of additional quantities, a member's treating physician must request prior authorization through the Pharmacy Management Precertification Unit. Additional quantities of these anti-migraine agents will be considered medically necessary for those members who meet ANY of the following criteria:

    • Documented diagnosis of acute migraine AND member is receiving prophylactic migraine therapy OR
    • Documented diagnosis of acute migraine AND member is being treated by a headache clinic or specialist.

  2. Medical Exception Criteria

    Axert, Frova, Relpax, Zomig and Zomig-ZMT are currently listed on the Aetna Formulary Exclusions List.* Therefore, they are excluded from coverage for members enrolled in prescription drug benefit plans that use a closed formulary, unless a medical exception is granted. Aetna considers Axert, Frova, Relpax, Zomig and Zomig-ZMT to be medically necessary for those members who meet the following criteria:

    A documented:

    • Contraindication to two preferred anti-migraine "triptan" alternatives OR
    • Intolerance to two preferred anti-migraine "triptan" alternatives OR
    • Allergy to two preferred anti-migraine "triptan" alternatives OR
    • Failure of an adequate trial of one day each of two preferred anti-migraine "triptan" alternatives.

Migraine prophylactic agents–
verapamil
diltiazem
propranolol
propranolol
atenolol
metoprolol
nadolol
divalproex sodium (DEPAKOTE)
trazodone
valproic acid (DEPAKENE)
 amitriptyline
imipramine
desipramine
protriptyline
nortriptyline
doxepin
sertraline (ZOLOFT)
paroxetine
topiramate (TOPAMAX)
bupropion (WELLBUTRIN)

*Information regarding Aetna's Preferred Drug List, Formulary Exclusions list, Precertification and Step-Therapy lists is available on our website. In addition, members should refer to their plan documents and may call the toll-free telephone number on their ID card for information regarding their benefits. Health care professionals also may obtain information by calling the Pharmacy Management Precertification Unit at 1-800-414-2386, or they can register to use our password-protected provider website. Visit www.aetna.com, select “Doctors & Hospitals” and choose “Physician Self-Service.” Once registration is completed, health care professionals may use our online Precertification/medical exception email request form.

The lists above are subject to change. Not all programs - for example step-therapy, precertification, and quantity limits - are available in all service areas (for example, step-therapy does not apply to fully insured New Jersey members).

Many medications on the Preferred Drug List are subject to manufacturer rebate arrangements between Aetna and the manufacturer of those medications. If the member's prescription benefits plan has a deductible or copay levels based on a percentage of Aetna's contracted rate with the participating pharmacy, the contracted rate does not include or reflect any manufacturer rebate arrangements between Aetna and the medication manufacturer. In prescription plans with a deductible or copayment or coinsurance tiers, use of drugs from the Preferred Drug List generally will result in lower costs to members. However, where the prescription plan utilizes a deductible or copayments or coinsurance calculated on a percentage basis, there could be some circumstances in which a preferred drug would cost the member more than a nonpreferred drug because (1) the negotiated pharmacy payment rate for the preferred drug may be more than the negotiated pharmacy payment rate for the nonpreferred drug, and (2) rebates received by Aetna from drug manufacturers are not reflected in the cost of a prescription drug obtained by a member. The Preferred Drug List is subject to change.

In evaluating clinically and therapeutically similar drugs for selection for the Preferred Drug List, Aetna reviews the costs of drugs and takes into account rebates negotiated between Aetna and drug manufacturers. Consequently, a drug may be included on the Preferred Drug list that is more expensive than a nonpreferred alternative before any rebates Aetna may receive from a drug manufacturer are taken into account. In addition, certain drugs may be chosen for “preferred” status because of their clinical or therapeutic advantages or level of acceptance among physicians even though they cost more than nonpreferred alternatives. The net cost to a self-funded plan sponsor for covered prescriptions will vary based on (1) the terms of Aetna's arrangements with participating pharmacies; (2) the amount of the member's copayment, coinsurance or deductible obligation under the terms of the plan; and (3) the percentage, if any, of rebates to which the plan sponsor is entitled under its agreement with Aetna. As a result, a self-funded plan sponsor's actual claim expense per prescription for a particular preferred drug may in some circumstances be higher than for a nonpreferred alternative.

For members in Texas, additions to the 2006 Preferred Drug List will be effective no later than January 1, 2006. In accordance with state law, fully insured members in Texas who are receiving coverage for medications that are removed from the Preferred Drug List during the plan year will continue to have those medications covered at the same benefit level until their plan's renewal date.

This definition of precertification is not the same as the definition used by Texas law. Our use of the term “precertification” relates to the prior authorization of your services by Aetna, based on our decision of whether the service is medically necessary. Precertification is not a guarantee of payment or “verification” as defined by Texas law.

California HMO members enrolled in a closed formulary benefits plan who are receiving coverage for medications that are moved to the Formulary Exclusions List, and California HMO members who are receiving coverage for medications added to the Precertification or Step-Therapy lists, will continue to have those medications covered, for as long as the treating physician continues prescribing them. This coverage, in accordance with state law, is only provided when the drug is appropriately prescribed and is considered safe and effective for treating the member's medical condition.

Nothing in this section shall preclude the prescribing health care professional from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions.

Place of Service:

    Outpatient

Special Notes:

According to the manufactures, these anti-migraine agents are not intended for the prophylactic therapy of migraine or for use in the management of hemiplegic or basilar migraine. Safety and effectiveness of these agents have not been established for cluster headache, which is present in an older, predominantly male population.

Ergot-containing drugs have been reported to cause prolonged vasospastic reactions. Because there is a theoretical basis that these effects may be additive, use of ergotamine-containing or ergot-type medications (like dihydroergotamine or methysergide) and any of these anti-migraine agents within 24 hours is contraindicated. Because their vasospastic effects may be additive, coadministration of more than one of these anti-migraine agents (5-HT1 agonists) within 24 hours of each other is not recommended.

The above policy is based on the following references:

  1. Anon. Drugs for migraine. Med Lett 1995; 37: 17-20.
  2. Ferrari MD. Migraine. Lancet 1998; 351: 1043-1051.
  3. Dahlof C, Winter P, Whitehouse H, and Hassani H. Randomized, double-blind placebo-controlled comparison of oral naratriptan and oral sumatriptan in the acute treatment of migraine [abstract]. Neurology 199748:A85.
  4. Klassen A, Elkind A, Asghamejad M, et al Naratriptan is effective and well tolerated in the acute treatment of migraine: Results of a double-blind, placebo-controlled, crossover study. Headache 1997;37(10):640-5.
  5. Mathew NT, Asgharnejad M, Peykamian M, et al. Naratriptan is effective and well tolerated in the acute treatment of migraine: Results of a double-blind, placebo-controlled, crossover study. Neurology 1997;49: 1485-90.
  6. Bomhof M, Paz J, Legg N, et al. Comparison of rizatriptan 10 mg vs. naratriptan 2.5 mg in migraine. Neurology 1999;423:173-9.
  7. Lipton RB. Methodologic issues in acute migraine clinical trials. Neurology 2000;55(Suppl 2):S1-7.
  8. Goadsby PJ and Hargreaves RJ. Mechanisms of action of serotonin 5HT 1B/1D agonists: Insights into migraine pathophysiology using rizatriptan. Neurology 2000;55(Suppl 2):S8-14.
  9. Silberstein SD, Goadsby PJ, and Lipton RB. Management of migraine: An algorithmic approach. Neurology 2000;55(Suppl 2):S46-52.
  10. 5-HT Agonist Comparisons: Clinical. BMMA. 1999;3(2):89.
  11. Jamieson DG. The safety of triptans in the treatment of patients with migraine. Am J Med. 2002;112:135-40.
  12. Jhee SS, Shiovitz T, Crawford AW, Cutler NR. Pharmacokinetics and pharmacodynamics of the triptan antimigraine agents. Clin Pharmacokinet 2001;40:189-205.
  13. Tepper SJ. Safety and rational use of the triptans. Med Clin North Am. 2001;85:959-70.
  14. Salonen R. Drug comparisons: why are they so difficult? Cephalalgia. 2000;29(Suppl 2):25-32.
  15. Rapoport AM, Tepper SJ. All triptans are not the same. J Headache Pain. 2001;2:S87-S92.
  16. Marcus DA. Establishing a standard of speed for assessing the efficacy of the serotonin 1B/1D agonists (triptans). Arch Neurol. 2001;58:1056-8.
  17. Ferrari MD, Roon KI, Lipton RB, Goadsby PJ. Oral triptans (serotonin 5-HT 1B/1D agonists) in acute migraine treatment: a meta-analysis of 53 trials. Lancet 2001;358:1668-75.
  18. Ryan Jr RE. Patient treatment preferences and the 5-HT 1B/1D agonists. Arch Intern Med. 2001;161:2545-53.
  19. Pascual J. Clinical benefits of early triptan therapy for migraine. Headache 2002;42(Suppl 1):S10-7.
  20. Goadsby PJ, Lipton RB, Ferrari MD. Migraine - Current understanding and treatment. N Engl J Med. 2002;346:257-70.
  21. Pascual J, Falk RM, Piessens F, et al. Consistent efficacy and tolerability of almotriptan in the acute treatment of multiple migraine attacks: results of a large, randomized, double-blind, placebo-controlled study. Cephalalgia 2000;20:588-96.
  22. Gras J, Cardelus I, Llenas J, Palacios JM. Cardiovascular safety profile of almotriptan, a new indolic derivative for the treatment of migraine. Eur J Pharmacol. 2000;410:53-9.
  23. Goldstein J, Keywood, and Hutchison J. Low 24-hour migraine recurrence during treatment with frovatriptan. Presented at Ninth Congress of the International Headache Society, Barcelona, Spain. June 22-26, 1999.
  24. Spierings ELH, Keywood C on behalf of the VML 251/96/08 investigators. Consistent migraine relief with frovatriptan, a novel 5-HT 1B/1D agonists. Present at the Ninth Congress of the International Headache Society, Barcelona, Spain. June 22-26, 1999.
  25. Elkind A, McDaris HL, Satin L, Keywood C. The cardiovascular safety of frovatriptan in patients at high risk of or with known coronary artery disease during a migraine attack. Presented at the Ninth Congress of the International Headache Society, Barcelona, Spain. June 22-26, 1999.
  26. Easthope SE and Goa KL. Frovatriptan. CNS Drugs 2001:15(12);969-76.
  27. Dodick DW. Oral almotriptan in the treatment of migraine: Safety and tolerability. Headache 2001;41:449-55.
  28. Visser WH et al. Rizatriptan vs sumatriptan in the acute treatment of migraine. A placebo-controlled, dose-ranging study. Arch Neurol 1996; 53: 1132-1137.
  29. Gijsman H et al. Double-blind, placebo-controlled, dose-finding study of rizatriptan (MK-462) in the acute treatment of migraine. Cephalalgia 1997; 17: 647-651.
  30. Santanello NC et al. Improvement in migraine-specific quality of life in a clinical trial of rizatriptan. Cephalalgia 1997; 17: 867-872.
  31. Teall J et al. Rizatriptan (Maxalt) for the acute treatment of migraine and migraine recurrence. A placebo-controlled, outpatient study. Headache 1998; 38: 281-287.
  32. Dahlof CGH, Rapoport AM, Sheftell FD, and Lines CR. Rizatriptan in the treatment of migraine. Clin Ther 1999;21(11):1823-36.
  33. Pascual J, Vega P, Diener HC, et al. Comparison of rizatriptan 10 mg vs. zolmitriptan 2.5 mg in the acute treatment of migaine. Cephalalgia 2000;20:455-61.
  34. Bomhof M, Paz J, Legg N, et al. Comparison of rizatriptan 10 mg vs. naratriptan 2.5 mg in migraine. Neurology 1999;423:173-9.
  35. Goldstein J, Ryan R, Jiang K, et al. Crossover comparison of rizatriptan 5 mg and 10 mg versus sumatriptan 25 mg and 50 mg in migraine. Headache 1998;38:737-47.
  36. Tfelt-Hansen P, Teall J, Rodriguez F, et al. Oral rizatriptan versus oral sumatriptan: A direct comparative study in the acute treatment of migraine. Headache 1998;38:748-55.
  37. Saper JR. The use of rizatriptan in the treatment of acute, multiple migraine attacks. Neurology 2000;55(Suppl 2):S15-8.
  38. Silberstein SD. Rizatriptan versus usual care in long-term treatment of migraine. Neurology 2000;55(Suppl 2):S25-8.
  39. Hargreaves RJ. Pharmacology and potential mechanisms of action of rizatriptan. Cephalalgia 2000;20(Suppl 1): 2-9.
  40. Sakai F. Safety and tolerability of rizatriptan. Cephalalgia 2000;29(Suppl 1):16-8.
  41. Adelman JU, Lipton RB, Ferrari MD, et al. Comparison of rizatriptan and other triptans on stringent measures of efficacy. Neurology. 2001;57(8):1377-83.
  42. Anon. Zolmitriptan for migraine. Med Lett 1998; 40: 27-28.
  43. Ferrari MD. The clinical effectiveness of 311C90 in the acute treatment of migraine. Eur Neurol 1996; 36(Suppl 2): 4-7.
  44. Thomsen LL et al. 311C90 (zolmitriptan), a novel centrally and peripheral acting oral 5-hydroxytryptamine-1D agonist: A comparison of its absorption during a migraine attack and in a migraine-free period. Cephalalgia 1996; 16: 270-275.
  45. The International 311C90 Long-term Study Group. The long-term tolerability and efficacy of oral zolmitriptan (Zomig, 311C90) in the acute treatment of migraine. An international study. Headache. 1998;38:173-83.
  46. Tepper SJ, Donnan GA, Dowson AJ, et al. A long-term study to maximize migraine relief with zolmitriptan. Curr Med Res Opin. 1999;15:254-71.
  47. Gallagher RM, Dennish G, Spierings ELH, Chitra R. A comparative trial of zolmitriptan and sumatriptan for the acute oral treatment of migraine. Headache 2000;40:119-28.
  48. Ryan RE, Diamond S, Rose AM, et al. Efficacy of zolmitriptan at early time-points for the acute treatment of migraine and treatment of recurrence. CNS Drugs. 2000;13:215-26.
  49. Palmer KJ, Spencer CM. Zolmitriptan. CNS Drugs 1997;7:468-78.
  50. Dowson A, MacGregor A, Brandes J, Eikermann A. Zolmitriptan orally disintegrating tablets provide effective, convenient migraine relief. Presented at the Tenth Congress of the International Headache Society, New York, NY. June 29-July 2, 2001.
  51. Yates R, Nairn K, Dixon R, Kemp V, Dane AL. Pharmacokinetics, dose proportionality, and tolerability of single and repeat doses of a nasal spray formulation of zolmitriptan in health volunteers. J Clin Pharmacol 2002;42:1244-1250.
  52. Syrett N, Abu-Shakra S, Yates R. Zolmitriptan nasal spray: advances in migraine treatment. Neurology 2003;61(S4):S27-30.
  53. Yates R, Narin K, Dixon R, Seaber E. Preliminary studies of the pharmacokinetics and tolerability of zolmitriptan nasal spray in heath volunteers. J Clin Pharmacol 2002l;42:1237-43.
  54. Charlesworth BR, Dowson AJ, Purdy A, Becker WJ, Boes-Hansen S, Farkkila M. Speed of onset and efficacy of zolmitriptan nasal spray in the acute treatment of migraine. CNS Drugs 2003;17(9):653-667
  55. Mathew NT, Schoenen J, Winner P, et al. Comparative efficacy of eletriptan 40 mg versus sumatriptan 100 mg. Headache. 2003;43:214-22.
  56. Sandrini G, Farkkila M, Burgess G, et al. Eletriptan vs sumatriptan. A double-blind, placebo-controlled, multiple migraine attack study. Neurology. 2002;59:1210-7.
  57. Rapoport AM & Sheftell FD. Intranasal medications for the treatment of migraine and cluster headache. CNS Drugs 1997; 7: 37-46.
  58. Wilkinson M et al. Migraine and cluster headache: Their management with sumatriptan: A critical review of the current clinical experience. Cephalalgia 1995; 15: 337-357.
  59. Winner P et al. A double-blind study of subcutaneous dihydroergotamine vs subcutaneous sumatriptan in the treatment of acute migraine. Arch Neurol 1996; 53: 180-184.
  60. Cady RC et al. Sumatriptan injection reduces productivity loss during a migraine attack. Arch Intern Med 1998; 158: 1013-1018.
  61. Cutler N et al. Oral sumatriptan for the acute treatment of migraine: Evaluation of three dosage strengths. Neurology 1995; 45(suppl 7): S5-S9.
  62. Sargent J et al. Oral sumatriptan is effective and well tolerated for the acute treatment of migraine: Results of a multicenter study. Neurology 1995 45(suppl 7): S10-S14.
  63. Rederich G et al. Oral sumatriptan for the long-term treatment of migraine: Clinical findings. Neurology 1995; 45(suppl 7): S15-S20.
  64. Diamond S et al. Multiple-attack efficacy and tolerability of sumatriptan nasal spray in the treatment of migraine. Arch Fam Med 1998; 7: 234-240.
  65. Perry CM & Markham A. Sumatriptan: An updated review of its use in migraine. Drugs 1998; 55(6): 889-922.
  66. Carpay HA, Matthijsse P, Steinbuch M, et al. Oral and subcutaneous sumatriptan in the acute treatment of migraine: an open randomized cross-over study. Cephalalgia. 1997;17(5):591-5.
  67. Gruffydd-Jones K, Hood CA, Price DB. A within-patient comparison of subcutaneous and oral sumatriptan in the acute treatment of migraine in general practice. Cephalalgia. 1997;17(1):31-6.
  68. Pfaffenrath V, Cunin G, Sjonell G, Prendergast S. Efficacy and safety of sumatriptan tablets (25 mg, 50 mg, and 100 mg) in the acute treatment of migraine: defining the optimum doses of oral sumatriptan. Headache. 1998;38(3):184-90.
  69. Pini LA, Sternieri E, Fabbri L, Zerbini O, Bamfi F, for The Oral Sumatriptan Italian Study Group. High efficacy and low frequency of headache recurrence after oral sumatriptan. J Int Med. Res 1995;23(2):96-105.
  70. Lipon RB, Stewart WF, Cady R, et al. Sumatriptan for the range of headaches in migraine sufferers: results of the spectrum study. Headache 2000;40:1-9
  71. Cady RK, Sheftell F, Lipton RB, et al. Effect of early intervention with sumatriptan on migraine pain: Retrospective analyses of data from three clinical trials. Clin Ther. 2000;22:1035-48.
  72. Hershey AD, Powers SW, LeCates S, Bentti AL. Effectiveness of nasal sumatriptan in 5- to 12-year-old children. Headache. 2001;41(7):693-7.
  73. Linder SL, Winner P. Pediatric headache. Med Clin North Am. 2001;84(4):1037-53.
  74. Olin BR, editor. Drugs Facts and Comparisons (electronic online version). St. Louis: J.B. Lippincott Company, 2004.
  75. USPDI Drug Information for the HealthCare Professional (online through Stat!Ref). Thomson MICROMEDEX, Greenwood Village, Colorado; 2004.
  76. McEvoy GK, editor. AHFS Drug Information (online through Stat!Ref). American Society of Health-Systems Pharmacists, Bethesda, Maryland; 2004.
  77. Amerge Product Information. GlaxoWellcome, Research Triangle Park, NC. May 2003.
  78. Axert Product Information. Pharmacia & Upjohn. May 2003.
  79. Frova Product Information. Elan, San Diego, CA, 2002.
  80. Imitrex Nasal Spray Product Information. GlaxoWellcome, Research Triangle Park, NC. June 2001.
  81. Imitrex Injection Product Information. GlaxoWellcome, Research Triangle Park, NC. March 2001.
  82. Imitrex tablets Product Information. GlaxoWellcome, Research Triangle Park, NC. June 2001.
  83. Maxalt Product Information. Merck, West Point, PA. October 2001.
  84. Relpax Package Information. Pfizer. New York, New York. September 2003.
  85. Zomig Product Insert. AstraZeneca, Wilmington, DE, July 2003.

Property of Aetna Inc. All rights reserved. Pharmacy Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.

January 1, 2006