Serotonin Agonists, Nasal
PDL Reference Documents
- Headache Treatment and Prevention - Apr 03, 2025
- Serotonin Agonists - Aug 06, 2020
- Migraine Treatment and Prevention - May 23, 2019
- Triptans - Mar 31, 2016
- Triptan Scan Summary - May 29, 2014
- Triptans DERP Scan - May 29, 2014
- Drug Class Review: Triptans - Jul 25, 2013
- Class Scan: Triptans - Mar 29, 2012
Drug Use Review Documents
PDL Status Values
Y = preferred
N = non-preferred. Non-preferred drugs listed as N but without clinical drug use criteria are subject to the
Non-Preferred Drugs in Select PDL Classes prior authorization criteria.
New drugs will be listed as N until reviewed by the P&T Committee and are subject to the
New Drug Policy.
V = voluntary non-preferred. Non-preferred mental health drugs are listed as V and prior authorization is not required.
Null (i.e. blank) = indicates the class or specific drug has not been reviewed for PDL placement.
To request a Prior Authorization, please use this form.
| Generic Name | Brand Name | Form | PDL Status |
Current Drug Use Criteria | New Drug Evaluation & Updates |
|---|---|---|---|---|---|
| sumatriptan | SUMATRIPTAN | SPRAY | Y | Quantity Limit | |
| zolmitriptan | ZOLMITRIPTAN | SPRAY | Y | Quantity Limit | |
| zolmitriptan | ZOMIG | SPRAY | Y | Quantity Limit | |
| sumatriptan | TOSYMRA | SPRAY | N | Quantity Limit |