Trends in utilization and costs of migraine medications, 2017–2020

Abstract

Objective This study examines changes in utilization and costs trends associated with migraine medications. Background Migraine attacks are a burden to many patients. There are many pharmacotherapy options available with newer migraine drug classes entering the market in the past decade. Little is known about the use, associated costs, and the impact of the newer agents. Methods This retrospective, cross-sectional study examined 2017–2020 administrative claims from a large national pharmacy benefits manager. Patients aged ≥ 18 years enrolled in commercial, Medicare, Medicaid, or health insurance exchange insurance plans who filled ≥ 2 prescription claims for triptans, ergotamines, isometheptenes, gepants, ditans, and CGRP mABs were included. A two-sample t-test was conducted to estimate whether differences in mean utilization and costs between 2017 and 2020 were statistically significant for migraine drug classes, except for CGRP mABs, which were estimated between 2018 and 2020. Results The sample ranged from 161,369 (2017) to 240,330 (2020) patients. 84.5% (n = 203,110; 2020) of patients were women. The number of 30-day adjusted prescription fills for prophylaxis remained stable over the four-year period, except for CGRP mABs, which increased from 0.5% (n = 0.007; 2018) to 5.3% (n = 0.075; 2020). Antiepileptics, antidepressants and beta blockers were the most common prophylaxes, while triptans, non-steroidal anti-inflammatory drugs/non-narcotic analgesics and opioids were the most common treatments utilized. CGRP mABs were the most expensive, while utilization of triptans were the highest. CGRP mABs had the largest increase in utilization (177.5%) and costs (166.3%) PPPM in 2020 ($291.17) compared to 2018 ($109.35), the year they were first available (p < 0.001). Between 2018 and 2020, costs increased overall and for commercial and Medicare enrollees, but remained unchanged for Medicaid and HIX members. Conclusion Our study demonstrates a shift in migraine medication utilization from 2017–2020, where increased use of CGRP mABs had a significant contribution to increased costs. These increased pharmacy costs must be weighed against the improved tolerability of these agents likely resulting in other healthcare and indirect cost savings.

Ketamine Applications for Migraines: A Scoping Narrative Review

“…Prophylactically, NSAIDs, analgesics, beta-blockers, CCBs, TCAs, antidepressants, and anti-epileptics have also been used, with newly approved pharmacological agents like anti-calcitonin gene-related peptides (anti-CGRPs) recently added to the repertoire 45 . Among these treatment options, anti-CGRPs are the most expensive at $291.17 per patient per month (PPPM) in 2020 while triptans are the highest volume use at $31.92 PPPM in 2020 47 . Further 2020 pricing PPPM includes $64.92 for opioids, $23.90 for NSAIDs/non-narcotic agents, $761.99 for ergotamine, $11.44 for antidepressants, $43.82 for anticonvulsants, and $13.40 for betablockers 47 .…”

“…Among these treatment options, anti-CGRPs are the most expensive at $291.17 per patient per month (PPPM) in 2020 while triptans are the highest volume use at $31.92 PPPM in 2020 47 . Further 2020 pricing PPPM includes $64.92 for opioids, $23.90 for NSAIDs/non-narcotic agents, $761.99 for ergotamine, $11.44 for antidepressants, $43.82 for anticonvulsants, and $13.40 for betablockers 47 . This wide variety of pricing options and choices for patients seeking migraine medications emphasizes the heterogeneity and individuality of migraine response and the importance of expanding on all potential treatment options.…”

Cabergoline as a Preventive Migraine Treatment: An Investigator-Initiated Randomized Controlled Trial

“…There is still an unmet need for more effective and well-tolerated preventive treatments of patients with episodic and chronic migraine. At the same time, the cost of migraine pharmacotherapies has increased dramatically, mainly due to the increased use of CGRP-targeted compounds 29 . In this context, repurposing of cabergoline would be an affordable option.…”

From CGRP to PACAP, VIP, and Beyond: Unraveling the Next Chapters in Migraine Treatment

“…Nevertheless, the responder rate varies depending on the type of and the duration of treatment, the response criteria, and the patient characteristics. Additionally, these drugs can be costly with limited insurance coverage [54]. While generally well-tolerated, CGRP-targeting mAbs can cause gastrointestinal disorders like constipation, and gepants can cause fatigue, nausea, dizziness, tiredness, and dry mouth [55].…”