Headache Vault Access Index

Component B — Payer Policy Landscape

Quarterly headache disorder payer policy data. Open and citable.

Every quarter, the Headache Vault publishes a versioned record of what changed in payer policies across all 50 states — step therapy requirements, formulary tier placements, Gold Card law adoption, and denial patterns. Every release is stable, dated, and CC BY licensed.

✓ CC BY 4.01,205 payers73,828 recordsAll 50 statesUpdated quarterlyPrimary sources verified

Dataset Coverage

What the dataset covers.

Step therapy requirements

Which payers require patients to fail one or more prior treatments before CGRP medications are authorized. Failure criteria and required medication classes by payer.

Formulary tier placements

Tier assignments (Tier 1–5+) for all CGRP mAbs (SC and IV), gepants (acute and preventive), and Botox across all payer formularies.

Gold Card law adoption

Whether each state has enacted a Gold Card law and which payers are subject to it. Gold Card laws exempt board-certified specialists from PA requirements for medications they frequently prescribe.

Denial patterns

Payer-specific denial codes and the clinical language associated with successful appeals. 420 denial codes across all payers.

PA criteria

What each payer requires for prior authorization approval — diagnosis requirements, trial and failure documentation, specialist attestation, and renewal criteria.

Specialist-only restrictions

Which medications require specialist initiation or attestation before a PCP can prescribe or continue treatment.

Covers all CGRP mAbs (Aimovig, Ajovy, Emgality, Vyepti), gepants acute (Nurtec ODT, Ubrelvy), gepants preventive (Qulipta), neurotoxins (Botox, LCD DL39909), and ditans (Reyvow). 1,205 payers, 73,828 records across 11 data files. Updated quarterly.

Release Log

Every maintenance window. Regardless of changes.

Each release is a permanent, unchanged record. No-change releases are published with "Dataset stable" — lack of change is a citable data point. Newest first.

2026

2026 Q1 — January Primary Refresh

Published March 2026

330 policy changes51 new payers1,204 payers totalAll 50 states

Doty A. Headache Vault Access Index: Payer Policy Dataset, 2026 Q1.
The Headache Vault; 2026. headachevault.com/research/policy/2026-q1. Accessed [date].

View release →

Upcoming releases

2026-Q3

Expected July 2026

July — Mid-year sweep

UHC, Cigna, CVS Caremark-managed payers. State regulation updates.

2026-Q4

Expected October 2026

October — ICD-10 update

Annual ICD-10 update check. Triggered changes from reported PA denials.

2027-Q1

Expected January 2027

January — Annual formulary reset

Full annual refresh across all payers.

Every record in the dataset carries a confidence classification reflecting the quality of its primary source. Only Audit-Derived and PBM-Inferred records appear in public releases. Gap-Manual-Review records are held from publication until a primary source is confirmed.

Audit-Derived

✓ Public

Verified against a primary source document — payer formulary PDF, medical policy bulletin, or state legislature record. The source URL or document reference is logged at time of import.

PBM-Inferred

✓ Public

Sourced from a credible indirect source — a PBM formulary database, claims analysis, or cross-referenced payer network document. Plausible but not primary-source verified. Included in public releases with this classification.

Gap-Manual-Review

✗ Held

Record not surfaced in Policy Pulse — either not found in available primary sources, flagged for conflicting data, or pending human review. Excluded from public releases.

License & Citation

✓ CC BY 4.0

All data is licensed under CC BY 4.0. Stable versioned URLs at /policy-pulse/[year]-[quarter] are suitable for citation in most contexts without a DOI. If your publication requires a DOI, contact us.

Full dataset (current version)

The Headache Vault. Headache Disorder Payer Policy Database [dataset].
CC BY 4.0. headachevault.com/research/policy. Updated quarterly.

Specific quarterly release

The Headache Vault. Headache Disorder Payer Policy Database, Q1 2026.
CC BY 4.0. headachevault.com/policy-pulse/2026-q1. Accessed [date].