OBJECTIVES: The calcitonin gene-related peptide (CGRP) monoclonal antibodies (MABs) erenumab, fremanezumab and galcanezumab are reimbursed in Ireland under the High Tech Arrangement for the prophylaxis of chronic migraine in adults who have failed three or more prophylactic treatments. Reimbursement is subject to a Health Service Executive (HSE)-Managed Access Protocol (MAP), introduced on 1^st September 2021. This study provides a summary of the number of applications for CGRP MABs submitted and an overview of the utilisation of CGRP MABs on the High Tech Arrangement.

METHODS: All reimbursement applications for CGRP MABs submitted to the HSE-Medicines Management Programme (MMP) through an online application system between 1 September 2021 and 30 April 2023 were reviewed. Data was extracted from the HSE-Primary Care Reimbursement Services (HSE-PCRS) national pharmacy claims database for the High Tech Arrangement, from 1 September 2021 to 30 April 2023. Analysis was performed using SAS^® 9.4 Software.

RESULTS: A total of 1,509 reimbursement applications were submitted between September 2021 and April 2023. Reimbursement has been approved for 96.2% (n= 1,452) of applications submitted.

There were 1,399 individual patients dispensed a CGRP MAB under the High Tech Arrangement between September 2021 and April 2023. The majority of patients in receipt of CGRP MABs were female (n= 1,141, 81.6%) and had a mean age of 45 years.

In April 2023, 1,069 individual patients were dispensed a CGRP MAB on the High Tech Arrangement. The proportion of patients in receipt of individual CGRP MABs was 56% (n= 599) fremanezumab (Ajovy^®), 38.3 % (n=409) erenumab (Aimovig^®), and 5.7 % (n=61) galcanezumab (Emgality^®).

CONCLUSIONS: When used in conjunction with health technology assessment, MAPs, an example of health technology management, enable access to new drug treatments for patients likely to derive most clinical benefit, while providing budgetary oversight and certainty for the payer.