‘Game changing’ migraine drugs on the horizon

Thirty-six million Americans, about 12% of the population, suffer from migraine headaches, according to the American Migraine Foundation. The condition costs the United States more than $20 billion each year; costs are attributed to direct medical expenses, such as doctor visits and medications, as well as indirect expenses such as missed work and lost productivity.

Patients who have migraines can represent a sizeable population in an employer’s benefit, with a high degree of utilization of various products, both for acute treatment and prevention, according to Nadina Rosier, PharmD, Health and Benefits practice leader, Pharmacy, Willis Towers Watson.

“Moreover, there are potential absence, productivity, and disability implications for payers that should be considered in the overall management of their benefits budgets,” she says. “Employers may look to health insurers to help address the lost time with helping employees get back to work.  Some preventive anti-migraine drug therapies may  not have complete effectiveness for each patient  and many of these drugs have cumbersome side effects that cause patients to become noncompliant. For example, some patients may not respond to treatments or some of the treatments such as triptans or dihydroergotamine, are contraindicated for patients with high blood pressure or coronary artery disease.”

Clinicians also need to examine whether the pain may be a symptom of another issue rather than a migraine headache, Rosier points out.

Migraine treatments

There is presently no silver-bullet treatment for migraines, says Cynthia Ambres, MD, KPMG strategy partner and a member of the firm’s Global Healthcare Center of Excellence. 

“The treatments are getting more precise as we learn more about the cause of migraines,” she says. “There may be less trial and error in alleviating migraine symptoms and causes as more personalized treatments hit the market. Newer drugs may add treatment costs, but the condition is debilitating and one the medical community has struggled treating for decades.”

Since most migraine medications are now generic, new pharmaceutical developments are mainly different dosage forms or new methods of administration for existing drugs-such as a nasal spray previously only taken orally, says April Kunze, director of formulary development and pipeline, Prime Therapeutics.

“Some manufacturers are also bringing new combination brands to market that contain triptans with nonsteroidal anti-inflammatory drugs. We anticipate very little use of the new products and will manage by encouraging use of effective, low-cost generic options.”

A combination of both acute medications and preventive medications can provide relief for migraine sufferers, adds Rosier. “Depending on the use of brand versus generic products, oral versus injectables, a payer’s costs associated with use of these products varies,” she says.

Acute medications for migraine sufferers include those used for pain management, such as opioids and ibuprofen. Patients also use triptans, most of which are available in generic form. Preventive drugs used on a chronic basis include beta-blockers and calcium channel blockers which are also used in the treatment of high blood pressure. “Antidepressants and ant-seizure medications have also been used by some sufferers as preventive treatment,” she says. 

OnabotulinumtoxinA (Botox, Allergan) for injection has also been indicated for chronic migraines with injections across the head and neck, but is more expensive treatment, according to Rosier.

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