Gepants (CGRP Receptor Antagonists)
What it is
A newer class of migraine treatments that block the CGRP receptor. Available as Nurtec ODT (rimegepant), Ubrelvy (ubrogepant), and Qulipta (atogepant). Some gepants treat acute migraine attacks; Qulipta is for prevention only; Nurtec ODT is FDA-approved for both. They are alternatives for patients who cannot tolerate or have failed triptans.
ICD-10 Codes
How it works
Small-molecule CGRP receptor antagonists. Unlike CGRP monoclonal antibodies, gepants are orally administered and work acutely (Ubrelvy, Nurtec ODT) or preventively (Qulipta, Nurtec ODT). Nurtec ODT has both acute and preventive FDA indications — the only medication in its class with dual labeling. No vasoconstriction mechanism, making them an option for patients with cardiovascular contraindications to triptans.
What patients need to know
Gepants are a newer type of migraine medication. Some treat a migraine once it starts; one (Qulipta) is taken daily to help prevent migraines; and one (Nurtec ODT) can do both. They dissolve under your tongue or swallow as a tablet. Because they work differently than triptans, they may be an option if triptans haven't worked for you or if you have heart conditions that make triptans unsafe.
Prior authorization
Acute gepants (Ubrelvy, Nurtec ODT) typically require triptan failure — usually 2 triptans at adequate dose. Qulipta (preventive) follows CGRP mAb step therapy logic — 2–3 failed oral preventives. Nurtec ODT's dual indication can complicate PA: payers may authorize for acute use but not preventive, or vice versa. MOH risk is lower than with triptans or NSAIDs — relevant for patients with high acute medication use days. Formulary placement varies widely; many commercial payers place gepants on specialty or non-preferred tiers.
Submitting a PA for gepants?
The PA Engine covers payer requirements for Nurtec ODT, Ubrelvy, and Qulipta — including triptan failure documentation. Free, no account required.
Run a gepant PA →