A recent trend in drug therapy is the rise of calcitonin gene-related peptide (CGRP) receptor antagonists for the treatment and prevention of migraines.
A relatively new class of drugs, the first CGRP antagonist was approved in 2018, with several more approved in the following years. As newer medications, CGRP antagonists come with high costs, and their wide adoption in the market has directly impacted workers’ comp, contributing to year-over-year increases in cost per script and cost per claim for migraine therapies.
This trend is not expected to change course, especially when considering the revised treatment recommendations by the American Headache Society in March 2024, which include CGRP antagonists as first-line treatment for the prevention of migraines.
According to the Workers Compensation Research Institute (WCRI) per-claim payments for migraine medications increased in 23 states from 2021-2023, averaging 3% of drug spend across the country, but as high as 7-15% in some states.
Looking into individual states helps provide more nuance to this trend, as the California workers’ comp system saw migraine drug prescriptions increase four-fold from 2018-2023, while drug spend for migraine agents increased eight-fold. The increases in drug spend were tied to six CGRP antagonists, with average payments ranging from approximately $649 to $1,675 per prescription. For context, most CGRP antagonists used for migraine prevention are monthly injections, while those used for acute treatment are taken as needed, meaning there could be fluctuations in prescriptions over time.
CGRP Antagonist Migraine Medications
Current FDA-approved CGRP antagonists include:
- Aimovig® (erenumab-aooe) autoinjector - 2018
- Ajovy® (fremanezumab-vfram) injection - 2018
- Emgality® (galcanezumab-gnlm) injection – 2018
- Ubrelvy® (ubrogepant) oral tablets - 2019
- Vyepti® (eptinezumab-jjmr) IV infusion - 2020
- Nurtec® ODT (rimegepant) oral disintegrating tablets - 2020
- Qulipta® (atogepant) oral tablets – 2021
- Zavzpret™ (zavegepant) nasal spray - 2023
Nurtec O.D.T., Ubrelvy and Aimovig have comprised the majority of migraine therapy spend over the last three years, with Qulipta tablets contributing to an increasing share over the last year.
Continue reading the article in full at RxInformer magazine online.
