Patient Utilization and Switching Patterns of Patient Assistance Programs (PAPs) for Monoclonal Antibodies Targeting the Calcitonin Gene-Related Peptide (CGRP) Pathway for Migraine Prevention: A Retrospective Cohort Study


Stockl K1, Multani JK1, Urman R2, Bensink M3, Wade RL1, Khodavirdi AC2, Lu J4, Gill K2
1IQVIA, Falls Church, VA, USA, 2Amgen, Thousand Oaks, CA, USA, 3Benofit Consulting, Brisbane, QLD, Australia, 4IQVIA, Plymouth Meeting, PA, USA


Manufacturers offer PAPs (e.g. free trial program, bridge program, copay card, eVoucher, denial conversion) to reduce out of pocket costs for patients. This study describes utilization and switching patterns of PAPs among patients treated with anti-CGRP pathway monoclonal antibodies (mAbs) for migraine prevention.


In this retrospective cohort study using IQVIA open-source pharmacy and medical claims, patients ≥18 years with ≥1 claim for erenumab, fremanezumab, or galcanezumab between 05/17/2018-10/31/2020 were identified and indexed on the date of their first claim. Patients were required to have ≥2 medical claims ≥30 days apart within the 360-day pre-index period and use of a pharmacy that consistently contributed data over 180-days of follow-up. Anti-CGRP pathway mAb claims, including those from PAPs, were stratified by payer, and further categorized as visible (commercial, copay card, eVoucher) or non-visible (free trial program, bridge program, denial conversion, cash) based on whether the claim would be expected to produce a record in adjudicated insurance claims databases. Use and switching of PAPs and payers were evaluated during follow-up.


Of the patients identified (n=233,472 erenumab, n=66,731 fremanezumab, n=123,715 galcanezumab), the majority used a PAP for their first claim: 128,411 (55%) erenumab, 45,406 (68%) fremanezumab, 71,614 (58%) galcanezumab.

Non-visible payers were billed for 107,817 (46%) erenumab, 23,293 (35%) fremanezumab, and 21,660 (18%) galcanezumab index claims. Among patients with a non-visible index payer, a switch to a visible payer occurred in 31,774 (29%) of erenumab, 4,518 (19%) of fremanezumab, and 9,817 (45%) of galcanezumab patients during follow-up. Median time to switch from non-visible to visible payer was 61, 70, and 41 days, respectively.


Use of PAPs and non-visible payers in insurance claims was common yet variable across anti-CGRP pathway mAbs. Therefore, cautious interpretation is warranted when assessing incident exposure to anti-CGRP pathway mAbs in studies using adjudicated insurance claims data.

Conference/Value in Health Info

2022-05, ISPOR 2022, Washington, DC, USA

Value in Health, Volume 25, Issue 6, S1 (June 2022)




Epidemiology & Public Health, Real World Data & Information Systems, Study Approaches

Topic Subcategory

Disease Classification & Coding, Health & Insurance Records Systems



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