How many Imitrex (sumatriptan) tablets does United Healthcare (UHC) approve per month for patients with frequent migraines?

UnitedHealthcare Coverage for Sumatriptan (Imitrex) Tablets

UnitedHealthcare typically approves 9 tablets of sumatriptan per month for migraine treatment, with a maximum of 200mg per day as per FDA labeling.

Coverage Details for Sumatriptan

Standard Monthly Quantity Limits

• UnitedHealthcare typically limits sumatriptan tablets to 9 tablets per 30-day period for most patients with episodic migraine 1
• This quantity limit aligns with FDA labeling that specifies a maximum daily dose of 200mg in a 24-hour period 1
• The standard approval is based on treating approximately 3 migraine attacks per month, with up to 3 tablets per attack (using the 50mg or 100mg strength) 2, 1

Clinical Rationale for Quantity Limits

• The FDA-approved maximum daily dose of sumatriptan is 200mg in a 24-hour period, with a recommended interval of at least 2 hours between doses 1
• Medication overuse headache is a significant concern when triptans are used on ≥10 days per month for ≥3 months 2
• Clinical guidelines recommend limiting acute medications to prevent medication overuse headache, which can complicate migraine management 2

Special Circumstances for Higher Quantities

• Patients with more frequent episodic migraines (8-14 headache days per month) may qualify for additional tablets through prior authorization 2
• For patients with chronic migraine (≥15 headache days per month), preventive therapy is strongly recommended rather than increasing acute medication use 2
• Patients with documented inadequate response to standard quantities may be eligible for higher quantities through the prior authorization process 2

Important Clinical Considerations

Dosing Options

• Available strengths: 25mg, 50mg, and 100mg tablets 1
• Recommended starting doses: 25mg, 50mg, or 100mg per attack 1
• 50mg dose may offer the best balance of efficacy and tolerability for many patients 3
• Maximum single dose should not exceed 50mg in patients with mild to moderate hepatic impairment 1

Safety Considerations

• Common side effects include paresthesia, warm/cold sensation, chest pain/tightness/pressure, neck/throat/jaw pain, vertigo, and fatigue 4, 1
• Contraindicated in patients with coronary artery disease, Wolff-Parkinson-White syndrome, history of stroke, peripheral vascular disease, uncontrolled hypertension, and severe hepatic impairment 1
• Should not be used within 24 hours of another triptan or ergotamine-containing medication 4, 1

Alternative Approaches

• For patients requiring more than 9 tablets per month, consider:
  • Adding preventive therapy (e.g., CGRP antagonists, topiramate, propranolol) 2
  • Using combination therapy (triptan with NSAID) to improve efficacy and potentially reduce frequency of use 2
  • Evaluating for medication overuse headache if migraines are becoming more frequent 2

Practical Application

• For episodic migraine patients (less than 15 headache days per month), the 9-tablet limit is typically sufficient for managing 3 migraine attacks per month 2, 1
• Patients should be counseled to begin treatment as soon as possible after migraine onset for optimal efficacy 2
• If 9 tablets per month is insufficient, providers should consider adding preventive therapy rather than requesting higher quantities of sumatriptan 2