New Migraine Biologics Seek to Win Over Patients Before Insurers

The new class of calcitonin gene-related peptide (CGRP) inhibitors for migraine relief appear to represent a major evolution in migraine therapy, but high costs may hinder patient access to the biologics, according to a paper in The American Journal of Managed Care. Anticipating this, biopharmaceutical makers are competing for payer formulary inclusion through some unprecedented means, explained the paper’s author Sheldon J. Rich, PhD, RPh.

“As these new agents jockey for market share position and acceptance by managed care, manufacturers have been taking the novel approach of providing the migraine drugs to commercially insured patients initially at no cost or using an outcome-based pricing strategy” for up to a year of therapy, wrote Dr Rich, president of SJR Associates and an adjunct clinical assistant professor at the University of Michigan. “The manufacturers may be hedging their bets by gaining patient acceptance before insurer acceptance, thereby hoping to add pressure to payers to cover or authorize therapy for a patient if their migraine therapy is producing the expected results.”

With the migraine biologics priced at around $6900 a year, Dr Rich predicted market differentiation among the three CGRP inhibitors may come down to ease of administration, patient support services, and patient preference, not to mention efficacy and safety data. 

“Given the hypercompetitive, multibillion-dollar biopharmaceutical market, rapid changes and surprising efforts to gain market share for new migraine therapies can be expected,” he wrote.

Consequently, a slate of payer mechanisms that balance patient access with budget issues will be necessary, he advised.

—Jolynn Tumolo

Reference

Rich SJ. Burden of migraine and impact of emerging therapies on managed care. The American Journal of Managed Care. 2019;25(2 Suppl):S35-S39