Migraine – Access & Reimbursement – Detailed, Expanded Analysis, Migraine Prophylaxis (US)

Since 2018, four novel calcitonin gene-related peptide (CGRP)-targeting monoclonal antibodies (MAbs)—Novartis / Amgen’s Aimovig, Eli Lilly’s Emgality, Teva’s Ajovy, and Lundbeck’s Vyepti—have launched for migraine prevention in the U.S. market. Use of the class has grown steadily, driven by unmet need and solid efficacy, especially in patients who have failed standard oral therapies. Competition is set to further intensify with the entry of two novel oral CGRP antagonists—Biohaven’s Nurtec ODT and AbbVie / Allergan’s atogepant—by the end of 2021, challenging the uptake of the new MAbs and long-established Botox. As high-cost alternatives, these agents will both expand treatment choice and increase cost of care substantially in a hitherto mostly generic market. This report assesses how U.S. primary care providers (PCPs) and neurologists will incorporate these new, premium-priced brands into their prescribing practices and how payer policies will impact physicians’ adoption.


  • How are the key brands covered on MCOs’ largest fully insured commercial plans, and what are the key formulary drivers in this market?
  • What approaches do payers use to manage utilization / costs of these brands? How do these restrictions impact PCPs’ and neurologists’ prescribing practices?
  • How compelling will oral migraine-specific alternatives be in this market both from a payer and physician perspective?
  • What discounts will payers expect to negotiate? What pharmacoeconomic data and contracting terms will be most influential in driving coverage decisions?

Geography: United States.

Primary research: Survey of 101 U.S. physicians (including 51 neurologists and 50 PCPs). Survey of 30 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 162.7 million lives nationally.

Key drugs covered: Botox, Aimovig, Ajovy, Emgality, Vyepti, Trokendi XR, Qudexy XR, Nurtec ODT, atogepan.


  • Reimbursement and contracting.
  • Access and prescribing.
  • Affordability of migraine therapies.
  • Opportunities and challenges for emerging therapies.


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, including up-to-date analysis of drug coverage and restriction policies and payer and prescriber perspectives on key marketed drugs and receptivity to emerging therapies.

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