Qulipta
Example Question Scenarios
Summary: This logic verifies the medication prescribed is Qulipta.
Parameters:
- Searches for the appropriate RxNorm code(s).
Summary: This logic verifies the medication prescribed is Qulipta.
Parameters:
- Searches for the appropriate RxNorm code(s).
Summary: This logic verifies the medication prescribed is Qulipta.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Searches for the following ICD-10 diagnosis code(s): G43.0*, G43.1*, G43.7*, G43.8*, G43.9*, G43.E* (wildcard pattern)
- Searches for the following SNOMED code(s): 37796009, 56097005, 4473006
- Uses the following unit of measurement: a
- Confirms value is greater than or equal to: 18
- References direction for use instructions for migraine medications.
ICD-10
G43.0* (4 codes)
Code | Description |
|---|---|
G43.001 | Migraine without aura, not intractable, with status migrainosus |
G43.009 | Migraine without aura, not intractable, without status migrainosus |
G43.011 | Migraine without aura, intractable, with status migrainosus |
G43.019 | Migraine without aura, intractable, without status migrainosus |
G43.1* (4 codes)
Code | Description |
|---|---|
G43.101 | Migraine with aura, not intractable, with status migrainosus |
G43.109 | Migraine with aura, not intractable, without status migrainosus |
G43.111 | Migraine with aura, intractable, with status migrainosus |
G43.119 | Migraine with aura, intractable, without status migrainosus |
G43.7* (4 codes)
Code | Description |
|---|---|
G43.701 | Chronic migraine without aura, not intractable, with status migrainosus |
G43.709 | Chronic migraine without aura, not intractable, without status migrainosus |
G43.711 | Chronic migraine without aura, intractable, with status migrainosus |
G43.719 | Chronic migraine without aura, intractable, without status migrainosus |
G43.8* (8 codes)
Code | Description |
|---|---|
G43.801 | Other migraine, not intractable, with status migrainosus |
G43.809 | Other migraine, not intractable, without status migrainosus |
G43.811 | Other migraine, intractable, with status migrainosus |
G43.819 | Other migraine, intractable, without status migrainosus |
G43.821 | Menstrual migraine, not intractable, with status migrainosus |
G43.829 | Menstrual migraine, not intractable, without status migrainosus |
G43.831 | Menstrual migraine, intractable, with status migrainosus |
G43.839 | Menstrual migraine, intractable, without status migrainosus |
G43.9* (4 codes)
Code | Description |
|---|---|
G43.901 | Migraine, unspecified, not intractable, with status migrainosus |
G43.909 | Migraine, unspecified, not intractable, without status migrainosus |
G43.911 | Migraine, unspecified, intractable, with status migrainosus |
G43.919 | Migraine, unspecified, intractable, without status migrainosus |
G43.E* (4 codes)
Code | Description |
|---|---|
G43.E01 | Chronic migraine with aura, not intractable, with status migrainosus |
G43.E09 | Chronic migraine with aura, not intractable, without status migrainosus |
G43.E11 | Chronic migraine with aura, intractable, with status migrainosus |
G43.E19 | Chronic migraine with aura, intractable, without status migrainosus |
SNOMED CT
Code | Description |
|---|---|
37796009 | Migraine (disorder) |
56097005 | Migraine without aura (disorder) |
4473006 | Migraine with aura (disorder) |
Summary: This logic checks if the patient has been on atogepant for at least 90 days of coverage over the past 2 years.
Parameters:
- Searches for the appropriate RxNorm code(s).
- Evaluates for this minimum total number of days specified medications (based on RxCUI) are active on the medication list: 90
- Evaluates this number of days in the past for active medication validity (written) dates: 730
Summary: This logic checks the patient's prescribed quantity against plan limits.
Parameters:
- Confirms value is less than or equal to: 1
- Uses the following NCIt (National Cancer Institute Thesaurus) unit code: c48542
- Searches for the appropriate RxNorm code(s)
- Confirms value is less than or equal to: 30
- Uses the following NCIt (National Cancer Institute Thesaurus) unit code: c48542
Refer to the QULIPTA® Prescribing Information for complete product details, including indications, dosing, contraindications, warnings, and adverse reactions.