Migraine – Access & Reimbursement – Access & Reimbursement – Migraine Prophylaxis (US)
Since 2018, the U.S. treatment landscape for migraine prophylaxis has undergone a major expansion with the entry of the novel calcitonin gene-related peptide (CGRP)-targeting monoclonal antibodies (MAbs) Aimovig (Novartis / Amgen), Emgality (Eli Lilly), Ajovy (Teva), and Vyepti (Lundbeck), followed by the oral CGRP antagonists (gepants) Nurtec ODT (Pfizer) and Qulipta (AbbVie). Use of these classes has grown steadily, driven by unmet need and solid efficacy, especially in patients who fail standard oral therapies. Competition is set to intensify, with the expanded labeling of the oral gepants hampering the uptake of the MAbs and long-established Botox. As high-cost alternatives, CGRP-targeting agents have both increased the number of treatments and substantially increased the cost of care in a previously highly genericized market. This report assesses how U.S. primary care physicians (PCPs) and neurologists have incorporated these new, premium-priced brands into their prescribing practices and how payer policies are affecting physicians’ adoption of these agents.
QUESTIONS ANSWERED
- What is the coverage status of key brands on commercial plans? What are common utilization management strategies that payers use to control costs?
- How do payer policies affect the prescribing of branded oral gepants (e.g., Nurtec ODT, Qulipta) and CGRP MAbs in this genericized market?
- What will be the anticipated impact of the label expansion of Qulipta—from just chronic migraine to all migraine frequencies—on payer policies and physician prescribing patterns for migraine prophylaxis?
- What are payers’ and physicians’ perspectives on the only emerging agent (Pfizer’s oral zavegepant) for migraine prophylaxis as the drug progresses in the pipeline?
Geography: United States
Primary research: Survey of 100 U.S. physicians (including 50 neurologists and 50 PCPs). Survey of 32 U.S. managed care organization (MCO) pharmacy directors and medical directors (PDs/MDs)
Fingertip Formulary: Formulary coverage and restrictions data for migraine preventives by commercial plans covering 169 million lives nationally
Key drugs covered: Botox, Aimovig, Ajovy, Emgality, Vyepti, Trokendi XR, Qudexy XR, Nurtec ODT, Qulipta
CONTENT HIGHLIGHTS
- Reimbursement and contracting.
- Access and prescribing.
- Affordability of migraine therapies.
- Opportunities and challenges for emerging therapies.
PRODUCT DESCRIPTION
U.S. Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of U.S. payer policy on physician prescribing behavior in the market access environment. Each report includes up-to-date analyses of drug coverage and restriction policies as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies.
SOLUTION ENHANCEMENT
Access & Reimbursement includes key analyses from Clarivate Real-World Data Product—comprehensive and timely data that provide clarity around the healthcare experiences and activities of hundreds of millions of patients, HCPs, and payers. Analyses include payer mix, percentage of claim rejections for key therapies, and reasons for claim rejection.
