Three Migraine Prevention Drugs Health Execs Need to Monitor

Insurers will need to closely monitor calcitonin gene-related peptide (CGRP) receptor blockers’ utilization and costs as they are expected to triple in the coming year, according to a new report.

CGRP drugs are biologic therapies that target and neutralize proteins present during a migraine episode.

New research from Prime Therapeutics LLC (Prime) shows a rapid, increased use of three new medicines to prevent chronic migraines. However, each of these new CGRP receptor blockers carries a wholesale cost of approximately $600 per month, and CGRP drug costs are expected to reach $15 million per month by the end of 2020-triple the cost seen in July 2019.

Prime researchers will present this study at AMCP Nexus October 29 to November 1, 2019, in National Harbor, Maryland.

The three CGRP drugs studied were FDA approved in 2018: Aimovig (erenumab-aooe) in May, Emgality (galcanezumab-gnlm) and Ajovy (fremanezumab-vfrm) in September. All three are prescribed preventively for individuals with intermittent or chronic migraines to reduce migraine frequency and severity.

“Understanding CGRPs real-world utilization, costs, adherence, switching, and associated changes to concurrent acute migraine medication use will inform insurers’ CGRP category management strategies,” says Patrick Gleason, PharmD, assistant vice president, health outcomes, at Prime.

Related: Watching the Drug Pipeline

Researchers analyzed pharmacy claims data among 15 million commercially insured members and found a total of 13,133 members started CGRP therapy during May 2018 through July 2019. The number of members who started on a new CGRP prescriptions increased steadily from six members in May 2018 to 1,809 members in July 2019-growth of about 129 additional new users per month.

Prime Therapeutics is forecasting that in the month of December 2020, the CGRP expense will be $15 million, a three-fold increase of the $4.8 million in July 2019.

While few members were found to switch CGRP therapy, 60% of members newly initiating a CGRP discontinued their therapy in the first six months, according to Gleason. “It is important insurers have value-based contracts in place to recoup the costs for early CGRP discontinuation. The high discontinuation rate is not surprising for two reasons: first, the severe, difficult to treat migraine patients are most likely those initially receiving therapy; second, poor migraine prophylaxis drug adherence has been seen with other agents; and third, provider CGRP samples may have been used without insurers’ knowledge.”

According to the study, CGRP initiation was found to have a potentially positive impact on opioid and triptan acute migraine medication utilization. This real-world study resulted in a statistically significant 5% decrease in members with an opioid claim in the six months after starting CGRP therapy.

“It’s in everyone’s-payer, provider and patient-best interest that individuals use the most appropriate medications and stay adherent to them to help avoid waste that drives up the total cost of healthcare,” Gleason says. “As emerging classes of therapies grow, there are opportunities to optimize medication use through utilization management programs.”

CGRP drugs represent the first biologic competition to Botox (Onabotulinumtoxin A) for chronic migraine prevention. In a real-world analysis of Botox treatment persistency, less than half of individuals initiating therapy received the four annual recommended treatments during their first year of therapy, indicating there is a need for other treatments.

Tracey Walker is senior editor of Managed Healthcare Executive.