Plan Design: Drug Treatment

Historically, many different drugs have been used to treat migraine symptoms and decrease the frequency of attacks. Whether over-the-counter or prescription medications, most were not developed specifically for migraines and many have side effects. Drug therapies for migraines generally fall into three buckets:

  • Over-the-counter medications for acute treatment (e.g. aspirin, Advil)
  • Prescription medications for acute treatment taken at the first sign of a migraine (multiple traditional drugs are available)
  • Prescription drugs taken on a regular basis to prevent migraines, including a new drug approved by the Food and Drug Administration (FDA)

Studies have shown that when migraine sufferers use medications that prevent headaches, their use of medical services and ultimately overall health care costs go down. Using this type of therapy can also reduce related productivity losses. Yet these drugs remain underused by doctors treating people with migraine.

Managing your formulary

Talk with your Pharmacy Benefit Manager (PBM) to understand what drugs are currently available for migraines, as well as their process for bringing new drugs to the formulary. Consider asking about:

  • Criteria for drug selection on the formulary
  • Quantity limits (if any)
  • Step therapy requirements (if any); for newer drugs, do they require that patients:
    • Have a certain number of headaches each month
    • Evidence that older medications have been tried first (for preventive, acute or both)
    • Get prescription from or in consultation with a neurologist or headache specialist with prior authorization

Prescription drug update

In May 2018, the FDA approved the first drug designed specifically to prevent migraines. This new class of targeted, disease-specific drugs, known as a Calcitonin Gene Receptor Peptide (CGRP) inhibitors, blocks the activity of CGRP, a molecule involved in migraine attacks. In clinical trials, half of the participants taking the drug had at least a 50% reduction in the frequency of migraines each month. To be eligible for these drugs, you must have four or more migraine days per month. Approximately 7% of those with migraines fall into this category.

With more migraine drugs like these in the pipeline, there is great promise for those suffering from the debilitating effects of chronic migraines. Considering that these drugs have shown to be effective in reducing the frequency of migraine attacks – with fewer side effects than other treatments currently available – they will no doubt be in high demand. The challenge for employers is affordability and accessibility. However, keep in mind that although the cost may be significant, only a small percent of the covered population will be candidates for these drugs.