OBJECTIVES:

To examine changes in utilization and associated costs of migraine medications due to the addition of newer migraine drug classes, namely calcitonin gene-related peptide (CGRPs) receptor antagonists.

METHODS:

This retrospective, cross-sectional study examined administrative claims from a large national pharmacy benefits manager from 2017-2020. Patients aged ≥18 years enrolled in commercial, Medicare, Medicaid or health insurance exchange insurance (HIX) plans who filled ≥2 prescription claims for either triptans, ergotamines, isometheptenes, gepants or ditans were included. Utilization was examined as the total number of 30-day adjusted prescription fills per-patient-per-month (PPPM). Annual costs for medications were defined as gross costs net of rebates PPPM. A two-sample t-test was conducted to estimate whether differences in mean utilization and costs PPPM between 2017 and 2020 were statistically significant at p<0.05 for migraine drug classes, except for CGRPs, which were estimated between 2018 and 2020.

RESULTS:

The final sample ranged from 161,369 (2017) to 240,330 (2020). 84.5% of patients were women (2020). The number of 30-day adjusted prescription fills for prophylaxis remained stable over the four-year period, except for CGRPs, which increased from 0.5% (2018) to 5.3% (2020) of all migraine drug utilization. Antiepileptics, antidepressants and beta-blockers were the most common prophylaxis classes, while triptans, NSAIDs/non-narcotic analgesics and opioids were the most common treatment classes. CGRPs were the most expensive migraine prophylaxis class, while triptans contributed most to migraine treatment. CGRPs had the largest increase in utilization (177.5%) and costs (166.3%) PPPM in 2020 compared to 2018, the year they were first available (p<0.001). Between 2018 and 2020, costs increased overall and for commercial and Medicare enrollees, but remained unchanged for Medicaid and HIX members.

CONCLUSIONS:

Our study demonstrates a shift in migraine medication utilization from 2017-2020, where increased use of CGRPs had a significant contribution, especially to cost increases for migraine drug classes.