Trudhesa™ Nasal Spray for the Treatment of Migraines

Migraine relief medications are frequently monitored and flagged for audit due to high cost, quantities submitted, days’ supply and/or frequency of refills. Trudhesa™ 4 mg/mL nasal spray was FDA approved on September 3, 2021. It is indicated for the acute treatment of migraine with or without aura in adults. While Migranal® and Trudhesa™ are both nasal sprays containing dihydroergotamine, Trudhesa™ is the newer form made to reach the bloodstream more quickly by being absorbed better through the nose. Pharmacies often struggle on billing Trudhesa™, due to some specific dosing and administration guidelines. Please see below for guidance on how to properly bill for this migraine relief medication.

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  • Trudhesa™ is for nasal administration only
  • Supplied as a package of four single-dose units (NDC# 77530-0725-04)
    • Each single-dose unit contains a 1 mL vial and an intranasal delivery device
  • Each device must be assembled and primed with exactly four sprays prior to use
    • The purpose of priming is to bring the medicine to the tip of the spray nozzle. You may or may not see liquid or spray come out of the nozzle during each priming pump
    • Each 1 mL vial contains 2 sprays (one dose) after the four priming sprays
    • NCPDP billing unit is mL – one package containing the four units is billed as 4 mL
    • There are a total of 4 doses or 8 sprays in each 4 x 1 mL package
    • A complete dose is 2 sprays, 1 spray in each nostril
    • If prescribed, the dose can be repeated at least one hour after the first dose
    • If an additional dose is needed, a new unit must be opened and prepared
  • Use or discard within 8 hours after vial has been opened or product has been assembled
  • Do not use more than two doses of Trudhesa™ within 24 hours or three doses within 7 days
  • If written for more than one package of 4 mL, it is best to have a notation from the physician as to the number of headaches the patient has per week or month to support billing multiple packages
  • See our updated Nasal Spray Chart on the PAAS Member portal for additional guidance on billing
  • See the December 2021 Newsline article, Self-Audit Series #11 – Migraine Prescriptions for further reference
  • Call PAAS (608) 873-1342 with questions on how to bill Trudhesa™
Jennifer Ottman, CPhT