About 39 million people in the United States have migraine, a condition characterized by severe throbbing head pain, nausea, vomiting and sensitivity to light and sound. The condition, the third most common in the world, creates an annual economic burden of approximately $78 billion in the United States, with annual direct and indirect costs of between $8,500 and $9,500 for each patient with migraine. Prime Therapeutics clients had over $1 billion in migraine drug expenditures in 2024, according to internal data. 

“Migraine is a complex condition with symptoms far beyond simply a headache,” said Marci Chodroff, MD, FACP, vice president, medical director, who last year hosted a webinar “Migraine insights: Beyond the headache.” “At Prime, we want to make sure members experience a smooth, seamless path to treatment. That’s why we’re committed to staying on top of the latest developments in migraine treatment options and offering solutions geared toward improving health outcomes and driving down drug costs so patients can focus on living, not just managing their condition.”  

Staying on top of the latest trends and treatments for migraine 

Migraine treatment has been an area of immense innovation in recent years — especially in the development of oral calcitonin gene-related peptide (CGRP) receptor antagonists, also known as gepants. These medications block the protein CGRP from attaching to its receptors throughout the body, stopping pain signals and reducing inflammation.   

In 2023, zavegepant (Zavzpret) became the first nasal spray gepant CGRP to treat acute migraine. Additionally, injectable CGRP monoclonal antibodies like erenumab (Aimovig), fremanezumab (Ajovy) and galcanezumab (Emgality) have also been approved by the U.S. Food and Drug Administration (FDA) for the preventative treatment of migraine, and Emgality is also approved for the treatment of episodic cluster headaches. More recently, in May 2025, dihydroergotamine (DHE) self-injected (Brekiya) was approved as the first and only DHE autoinjector to treat migraine and cluster headaches, and the first DHE nasal powder (Atzumi) was approved in April for acute treatment of migraine. The FDA also recently granted marketing authorization to the first prescription digital therapeutic (CT-132) for preventative treatment of episodic migraine. Prime’s clinical teams continuously monitor the drug development pipeline and publish their analyses of the latest drug approvals, and forthcoming FDA decisions, in monthly publications, which include any developments in migraine therapy. 

“We know that most individuals who have migraine try multiple different therapies before they find their best fit,” said Maryam Tabatabai, PharmD, associate vice president of clinical information, who helps oversee Prime’s clinical publications. “That’s why we feel it’s so important for us at Prime to help health plans and health care providers understand the value of the latest treatments, so they can prescribe and cover the most effective, yet affordable, therapies for migraine disorder.” 

Moreover, the clinical guidelines for prescribing therapy are constantly changing as evidence evolves. For example, the latest Prime Clinical Highlights publication, newly rebranded as Trending Topics & Drug Approvals, shares how the American College of Physicians recently published guidelines for treating acute episodic migraine in the outpatient setting. The organization recommends using a triptan added to a non-steroidal anti-inflammatory drug (NSAID) or suggests acetaminophen for those who don’t experience benefits on NSAIDs or acetaminophen alone in select patients. 

Prime also conducts research to evaluate the efficacy and cost-effectiveness of various treatments. A 2022 study by Prime’s health outcomes team evaluated real-world triptan use among 15 million commercially insured members. The study found that half of patients who used triptan medications for migraines didn’t refill their prescription and only 1 in 10 tried more than one type of triptan within a year. The same pattern continued after two years. These low refill and switch rates suggest patients may not be satisfied with triptan therapy. 

“Understanding real-world migraine drug usage patterns can help health care decision-makers decide how to cover and manage newer migraine treatments,” said Pat Gleason, assistant vice president, health outcomes. “At Prime, we’re honored to contribute to the understanding of drugs are used in the real world.”  

Industry-leading solutions help drive down drug costs, improve health outcomes 

In addition to having a finger on the pulse of pharmacy advancements, Prime offers a number of clinical products and solutions aimed at improving health outcomes and cost-effectiveness.  

As a leading pharmacy benefit manager (PBM), Prime offers flexible value-based contracts (VBCs) through its Best in Care^® product, providing cost caps and clinical management to support better health outcomes. Clinical tools help ensure appropriate use of migraine medications, preventing misuse and aligning treatment with the latest clinical guidelines to help reduce drug waste, keep costs lower and ensure availability of supplies for those who need it. These extra layers of management in both traditional and specialty drug categories help health plans compete in the commercial space.  

“We want members with chronic conditions like migraine to receive optimal care, which in turn encourages adherence and improved outcomes,” said Michelle Jacobson, senior trade client relations director. “Best in Care combines VBCs, clinical oversight and personalized support to help make migraine therapies more affordable and accessible.”  

Affordability is also a key mission of Prime’s, and that’s where Prime's industry-leading HighTouchRx^® program can help. Through a combination of data-driven analytics, pharmacist outreach and personalized intervention strategies, HighTouchRx helps drive down the cost of migraine and specialty medications. According to internal data, the product has helped save clients more than half a million on migraine drugs. 

A new migraine preventive program at Prime 

Prime is committed to providing access to the right medications for members during their medication journey. Through optimal medication management, GuidedHealth^® helps Prime’s members make better medication management decisions by improving drug safety and addressing medication adherence, gaps in care, unsafe use and potential misuse. Very soon, GuidedHealth will add a new Migraine Preventive Therapy program for all lines of business that offers migraine prevention interventions in support of the PQA Migraine Preventive Therapy (MPT) measure.  

“We are excited to introduce this new program to help manage preventive therapies for treating migraine,” said Sara Manderfield, director, clinical program capabilities. “Migraine episodes can be very debilitating, so we’re excited to help pave new pathways to better health.”  

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June is National Migraine & Headache Awareness Month 

Prime Therapeutics joins the Coalition for Headache and Migraine Patients (CHAMP) and the headache, migraine and cluster headache community to raise awareness about headache disorders during National Migraine & Headache Awareness Month in June. This month is dedicated to raising awareness, addressing the stigma and building more advocacy around the impact of these conditions. Join Prime in supporting those affected by migraine and working toward better care, research and understanding. Learn more at MigraineHeadacheAwarenessMonth.org.  

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Learn more about how Prime helps clients and members manage migraine   

Hear from a physician clinical reviewer at Prime who shares what you should know about migraine

Hear how Prime Therapeutics is reimagining pharmacy for its loved ones 

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