Migraine – Access & Reimbursement – Access & Reimbursement – Migraine Prophylaxis (US)

Preventive migraine care in the United States continues to evolve. Since 2018, CGRPtargeting mAbs (Aimovig, Emgality, Ajovy, Vyepti) and oral gepants (Nurtec ODT, Qulipta) have become established options beyond legacy generics, especially in patients who have failed standard oral therapies. Qulipta’s 2023 label expansion to chronic migraine has further entrenched the drug as an oral preventive option and intensified competition with monoclonal injectables and Botox. Ajovy has become the first antiCGRP preventive approved for pediatric episodic migraine, broadening specialist and primary care use. While these premium-priced therapies have meaningfully broadened physician and patient choice, they have also driven higher overall spend. At the same time, class-wide safety updates (hypertension/Raynaud’s phenomenon) have reinforced the need for ongoing monitoring. Payers continue to actively manage utilization through utilization management strategies, making treatment sequencing increasingly critical. This report examines how U.S. primary care providers (PCPs) and neurologists have incorporated these new, premium-priced brands into their prescribing practices and how payer policies have impacted 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 are payers’ and physicians’ perspectives on Lundbeck’s antiPACAP38 MAb as the drug progresses in the pipeline?
• · What impact could Merz Therapeutics’ Xeomin and Ipsen’s Dysport have on AbbVie’s Botox in migraine—across clinical adoption, pricing/contracting dynamics, payer policies, and step therapy?

Geography: United States

Primary research: Survey of 100 U.S. physicians (including 50 neurologists and 50 PCPs). Survey of 30 U.S. managed care organization (MCO) pharmacy directors and medical directors (PDs/MDs) and interviews with 2 U.S. MCO PD / MDs

Fingertip Formulary: Formulary coverage and restrictions data for migraine preventives by commercial plans covering 163 million lives nationally

Key drugs covered: Botox, Aimovig, Ajovy, Emgality, Vyepti, Trokendi XR, Qudexy XR, Nurtec ODT, Qulipta, Xeomin, Dysport, Bocunebart

Key analyses

• Reimbursement and contracting.
• Access and prescribing.
• Buy & bill calculations and analysis
• Couponing and patient affordability.
• Opportunities and challenges for emerging therapies.

PRODUCT DESCRIPTION

Leveraging Clarivate’s proprietary data sources and surveys with physicians and payers, Access & Reimbursement provides integrated brand- and disease-level insight on reimbursement dynamics and the impact of payer policy on physician prescribing behavior in the United States. Through detailed analyses of drug coverage, restriction policies, and contracting, as well as payer and prescriber perspectives on key marketed drugs and their receptivity to emerging therapies, this report enables you to:

• Identify and learn how to overcome roadblocks to market access to best position your brand.
• Identify key stakeholders and reimbursement drivers and assess the impact that reimbursement decisions have on treatment selection.
• Evaluate competitor strategies for securing favorable market access terms.