Prime Therapeutics study finds use, costs for new migraine prevention medications projected to triple by 2020

EAGAN, Minn. – New research from Prime Therapeutics LLC (Prime) shows a rapid, increased use of three new medicines to prevent chronic migraines. However, each of these new calcitonin gene-related peptide (CGRP) receptor blockers carries a wholesale cost of approximately $600 per month, and CGRP drug costs are expected to reach $15 million per month by the end of 2020 – triple the cost seen in July 2019. One positive, this real-world study also showed a statistically significant decrease (5%) in the number of members with an opioid claim in the six months after starting CGRP therapy.

The three CGRP drugs studied were approved by the Food and Drug Administration (FDA) in 2018: Aimovig™® (erenumab-aooe) in May, and Emgality®® (galcanezumab-gnlm) and Ajovy™ (fremanezumab-vfrm) in September. All three are prescribed preventively for individuals with intermittent or chronic migraines to reduce migraine frequency and severity.

CGRP drugs are biologic therapies that target and neutralize proteins present during a migraine episode. Alternate preventive migraine therapies include oral generic drugs and the injected biologic drug, Botox®. Acute medications – such as opioids and triptans – are used to relieve pain and other symptoms quickly. Since CGRPs are fairly new to market, this study produced much needed, real-world findings in that it measures the change in acute migraine medication use by individuals after they began using any of the three new migraine prevention CGRP drugs.

Researchers analyzed pharmacy claims data among 15 million commercially insured members and found a total of 13,133 members started CGRP therapy during May 2018 through July 2019. The number of members who started on a new CGRP prescription increased steadily from six members in May 2018 to 1,809 members in July 2019 – growth of about 129 additional new users per month.

Members new to CGRP therapy with six months of continuous enrollment prior to and after CGRP initiation were included in the analyses to examine changes in acute migraine medication use prior to and after CGRP initiation. A total of 3,555 members started CGRP therapy during May 2018 through January 2019. Of the 3,555 members newly using a CGRP, 2,758 individuals had the required six months of continuous enrollment prior to and after CGRP initiation. Changes in these members’ use of acute migraine medications were evaluated from six months before they started on a CGRP to six months after they began the therapy. Of the members new to CRGP therapy, 1,025 (37.2%) members had an opioid claim in the six months before starting on a CGRP, compared to 976 (35.4%) members with an opioid claim in the six months after starting it. This difference equates to nearly a 5% reduction in members with an opioid claim. Similarly, the number of members with a triptan pharmacy claim decreased by nearly 10% in the same timeframe.

“Prime continually leverages its industry-leading capabilities to measure the real-world outcomes of new specialty drugs,” said Patrick Gleason, PharmD, assistant vice president, health outcomes for Prime. “The migraine category is expensive and presents a golden opportunity to collaborate with manufacturers on guaranteeing their drugs are priced to the value they claim to deliver. This research helps us refine the patient outcomes measures built into our manufacturer value-based agreements to drive toward optimal health outcomes – in this case, lower use of opioids.”

Further research is needed to determine long-term impact on opioid use patterns resulting from consistent CGRP use, but Prime expects to see greater reductions in the use of acute medications among individuals who take their CGRP treatment as directed for over six months.

Prime researchers will present this study at AMCP Nexus Oct. 29-Nov. 1 in National Harbor, Md.