ZAVZPRET (zavegepant)

Zavzpret (zavegepant)

Self-Administration – Intranasal

Diagnosis considered for coverage:

• Acute Treatment of Migraine: Indicated for the acute treatment of migraine with or without aura in adults. 

Coverage Criteria:

For diagnosis of acute treatment of migraine:

• Diagnosis of migraine with or without aura, AND
• Dose does not exceed 10 mg per day (limit of 8 devices per month); AND
• Patient is 18 years of age or older, AND
• Will be used for the acute treatment of migraine, AND
• One of the following:
  • Trial and failure or intolerance to two triptans (e.g., eletriptan, rizatriptan, sumatriptan)
  • Contraindication to all triptans, AND
• Trial and failure, or intolerance to one of the following:
  • Ubrelvy
  • Nurtec ODT, AND
• If patient has 4 or more headache days per month, patient must be currently treated with one of the following:
  • Elavil (amitriptyline) or Effexor (venlafaxine) unless there is a contraindication or intolerance to these medications
  • Depakote/Depakote ER (divalproex sodium) or Topamax (topiramate) unless there is a contraindication or intolerance to these medications
  • A beta-blocker (i.e., atenolol, propranolol, nadolol, timolol, or metoprolol) unless there is a contraindication or intolerance to these medications
  • Atacand (candesartan) unless there is a contraindication or intolerance to this medication
  • Generic lisinopril unless there is a contraindication or intolerance to this medication, AND
• Medication will not be used in combination with another CGRP inhibitor for the acute treatment of migraines.

Reauthorization Criteria:

For diagnosis of acute treatment of migraine:

• Patient has experienced a positive response to therapy (e.g., reduction in pain, photophobia, phonophobia, nausea), AND
• Will not be used for preventive treatment of migraine, AND
• Medication will not be used in combination with another CGRP inhibitor for the acute treatment of migraines

Coverage Duration: 

• Initial: 3 months
• Reauthorization: 12 months

Authorization is not covered for the following:

The following conditions, and other uses of this drug for indications not listed in this policy, do not meet the coverage criteria established by the Western Health Advantage (WHA) Pharmacy and Therapeutics (P&T) Committee.

• Preventive treatment of migraine.

Additional Information: 

• The maximum dose of Zavzpret in a 24-hour period is 10 mg (one spray). The safety of using more than 8 doses in a 30-day period has not been established.
• The safety and effectiveness in pediatric patients has not been established.
• Concomitant administration of Zavzpret with intranasal decongestants may decrease the absorption of zavegepant. Avoid concomitant administration of intranasal decongestants with Zavzpret. When concomitant use is unavoidable, intranasal decongestants should be administered at least 1 hour after Zavzpret administration 

Policy Updates:

• 11/14/2023 – New policy approved by P&T.

References:

1. Zavzpret Prescribing Information. Pfizer Inc. New York, NY. March 2023.
2. AHS Consensus Statement. Update on integrating new migraine treatments into clinical practice. Headache. 2021 Jul;61(7):1021-1039.