With CGRP drugs on the horizon, patient perspectives are more vital than before.

In November 2017, the Institute for Clinical and Economic Review (ICER) was assessing a new migraine treatment option, erenumab, to determine its cost-effectiveness. The American Migraine Foundation was asked to provide ICER with migraine patient perspectives and information about the migraine experience to inform the report.

ICER’s final report will be used by insurance companies to determine whether they will cover this medicine (and other future medicines in this class), what tier the medicine will be on in insurance plans, and what types of authorization will be required. These decisions will heavily impact the access people with migraine have to this new class of medicines.

With the help of Move Against Migraine community members, our Board of Directors submitted the following comments:

“As ICER develops its Scoping Document, we emphasize the importance of keeping the patient perspective at the core of your assessment, and ask you to consider the following points:

  • There has never been a medication developed specifically to prevent migraine. There are only 4 oral medications approved for the prevention of migraine. Only one-third of those with chronic and less than 15% of episodic migraine sufferers who should be offered preventive care have received a prescription or recommendation for prevention. Of those who do receive an oral preventive medication, over 80% discontinue the medication within one year. The major reasons for discontinuation are the lack of efficacy and poor tolerability due to side effects. Many people living with migraine have tried everything available in their toolbox without relief.
  • The new class of medications – antibodies targeting calcitonin gene-related peptide (CGRP) – represent a major, indeed groundbreaking advance in the preventive treatment of migraine. The efficacy and very favorable tolerability profile of these biologics increase the likelihood that patients can adhere to and comply with the therapy and therefore receive long-term benefit and improved health care outcomes.
  • For many, migraine negatively impacts their ability to work because of employer misunderstanding, and missed days due to a lack of “sensory-free” zones in the workplace (light, noise, smells). Furthermore, people living with migraine currently and historically have been stigmatized by family and friends, resulting in damaged relationships with spouses, children, siblings, parents, and friends because of countless hospitalizations, absences in family life and cancellations
  • Many insurance plans only cover a limited quantity of medications per month, leaving patients without medication on some days, or forcing them to ration them.
  • There are not nearly enough headache specialists in the country to treat the number of people living with migraine. Therefore, most people see general neurologists or primary care physicians who may not be properly equipped to treat migraine effectively.
  • We believe the most important treatment outcomes to those living with migraine are improved quality of life and functional performance through the relief of the pervasive and disabling symptoms of migraine. 
In conclusion, the impact of migraine is complex, debilitating and far-reaching. As ICER prepares this important analysis, we urge you to consider and incorporate our input and ask that you please keep us and the larger migraine community engaged throughout each step of the process.”