Migraine — Acute and Preventive Medication Refills Treatment
Covered by Aetna in California

Acute therapy: sumatriptan 50–100mg oral at headache onset, may repeat once after 2 hours (max 200mg/day); sumatriptan 6mg SQ injection for severe attacks with early vomiting; rizatriptan 10mg ODT for faster dissolution when nausea is present. Preventive therapy (≥4 migraine days/month): topiramate 25–100mg daily (Tier 1 generic, effective for episodic and chronic migraine per AAN guidelines); propranolol 40–160mg daily (Tier 1, avoid in asthma/COPD); amitriptyline 10–75mg nightly (Tier 1, also treats comorbid insomnia/anxiety)

Rimegepant 75mg ODT (Nurtec — acute + preventive if taken every other day; approved for both uses; requires triptan step therapy for acute use or antiepileptic/beta-blocker/antidepressant trial for preventive use); erenumab 70–140mg monthly SQ (Aimovig — CGRP receptor mAb; requires PA + step therapy through oral preventives; conditionally first-line per AHS 2024); galcanezumab 120mg monthly SQ (Emgality — CGRP ligand mAb, also approved for episodic cluster headache); lasmiditan 50–200mg (Reyvow — 5-HT1F agonist, works without vasoconstriction, safe in cardiovascular disease — requires PA, triptan step therapy); naproxen 500mg + sumatriptan 85mg combination (Treximet — Tier 3, excluded on some Aetna plans)

Tier 1 generics covered: sumatriptan, rizatriptan, zolmitriptan, topiramate, propranolol, amitriptyline, valproate, candesartan (~$4–$25/month). CGRP mAbs (Aimovig, Ajovy, Emgality) covered with PA + step therapy; specialty tier copay $50–$150/month depending on plan after PA. Gepants for acute use (Ubrelvy, Nurtec) covered with step therapy through 2 triptans; ~$50–$100/month specialty copay. OnabotulinumtoxinA (Botox for chronic migraine — ≥15 headache days/month) covered under medical benefit with PA, not pharmacy benefit.

AAN 2024 Guidelines and AHS 2024 Position Statement support CGRP-targeting therapies as first-line for migraine prevention — a significant upgrade from previous 'second-line after oral preventives' status. Aetna CA step therapy policy still requires oral preventive trial first, but intolerance/contraindication documentation allows bypass. Triptans are contraindicated in patients with established coronary artery disease, uncontrolled hypertension, or cerebrovascular disease — lasmiditan or gepants are preferred acute agents in those patients. Medication overuse headache (MOH) — using acute medications >10–15 days/month — can cause rebound headache and requires a detoxification plan. Onabotulinumtoxin A (Botox) for chronic migraine (≥15 days/month, ≥8 migraine features) is an in-person procedure — TDMD refers to neurology for Botox candidacy assessment.

Yes, under current Aetna CA Non-Medicare policy (2761-E, updated 2024), CGRP monoclonal antibodies (Aimovig, Ajovy, Emgality, Vyepti) require step therapy: you must have a documented 56-day trial of at least one traditional oral preventive from any of three classes — antiepileptics (topiramate, valproate), beta-blockers (metoprolol, propranolol), or antidepressants (amitriptyline, venlafaxine). The AHS 2024 Position Statement explicitly recommends CGRP therapies as first-line options, which creates grounds for a PA appeal if you've had documented contraindications or intolerances to the step therapy drugs. Dr. Bhavsar will document your clinical history to support either the step therapy pathway or an intolerance-bypass PA.

Yes. For Nurtec ODT (rimegepant) and Ubrelvy (ubrogepant), Aetna CA step therapy under Policy 3481-E requires documentation of at least a 30-day supply of two different triptan 5-HT1 agonists within the past 180 days. If you've tried sumatriptan and rizatriptan (or any two triptans) with inadequate response or intolerance, Dr. Bhavsar can document this during your visit and submit the PA or verify you meet the auto-approval step therapy criteria. Gepants are preferred over triptans in patients with cardiovascular contraindications to triptans.

Yes. Options available via telehealth prescription include: prochlorperazine 10mg oral or rectal (antiemetic with anti-migraine properties, Tier 1 generic — useful for attacks with prominent nausea and triptan failure); naproxen sodium 550mg for adjunctive anti-inflammatory effect with sumatriptan; dihydroergotamine nasal spray (DHE 45 nasal — for patients who tolerate ergotamine class, requires PA on some plans); or ondansetron 4–8mg ODT for refractory nausea during attacks. Parenteral rescue medications and IV DHE for status migrainosus (migraine lasting >72 hours) require emergency room or infusion center care — Dr. Bhavsar will identify the appropriate level of care.

TDMD can help you document eligibility and refer you to a California neurologist or headache specialist for Botox evaluation, but the injections themselves must be performed in-person. OnabotulinumtoxinA (Botox, 155–195 units across 31 sites) for chronic migraine (≥15 headache days/month, ≥8 migraine-quality days) is covered under the Aetna CA medical benefit — not pharmacy benefit — with PA. Criteria require chronic migraine diagnosis and typically prior failure of at least two oral preventives. Dr. Bhavsar can document your migraine frequency, prior oral preventive trials, and functional impairment in your visit summary to expedite a neurology referral and PA.

Yes. Aetna commercial plans cover telehealth visits for Migraine — Acute and Preventive Medication Refills in California. TeleDirectMD (Dr. Parth Bhavsar, MD, NPI: 1104323203) is an in-network telehealth provider with Aetna in California. Your standard Aetna telehealth copay applies — typically $10–$40 for most commercial plans. If clinically appropriate, your prescription is sent to your California pharmacy immediately after your visit.

Most Aetna commercial plans in California have telehealth copays of $10–$40. Often $0–$20 for employer plans. Your exact cost depends on your specific plan and whether your deductible has been met. Log into your Aetna member portal or call the member services number on your card to verify your telehealth copay before your migraine medication refills visit. Self-pay is always available for a flat $49 if you prefer to skip insurance.

If your specific Aetna plan is not in-network with TeleDirectMD in California, or if your deductible has not yet been met, you can book as a self-pay patient for a flat $49 fee — same physician, same quality of care, no insurance needed. You may also be eligible to submit an out-of-network claim to Aetna for partial reimbursement depending on your plan's out-of-network benefit.

TeleDirectMD typically offers same-day and next-day video visits. Book at teledirectmd.com/book-online and select a time that works for you. Most patients are seen within a few hours of booking during business hours. Your migraine medication refills symptoms are evaluated by Dr. Bhavsar, MD — not a nurse practitioner or PA — ensuring you receive a board-certified clinical assessment.

Yes. TeleDirectMD is operated by Dr. Parth Bhavsar, MD (NPI: 1104323203), a board-certified Family Medicine physician. TeleDirectMD is LegitScript certified, HIPAA compliant, and is contracted as an in-network telehealth provider with Aetna in California. Claims are billed using standard CPT codes (99213/99214) and submitted electronically to Aetna.

Yes. Telehealth visits with a licensed physician are qualified medical expenses eligible for FSA (Flexible Spending Account) and HSA (Health Savings Account) payment. If your Aetna plan applies your deductible first, your FSA or HSA card can be used to pay your portion. The $49 self-pay option is also FSA/HSA eligible.