High-quality migraine medications that are effective for preventing migraines, treating headaches caused by drugs are difficult to access

A new study shows that the FDA-approved oral migraine drug atogepant is effective for the relief of difficult-to-treat “medication overload” that results from using many other pain relievers. However, patients often have to jump through hoops to get it covered by their insurance company.

Migraines affect approximately one in eight adults in the US Migraines are also the leading cause of disability in adults under the age of 50 in the United States. This high number highlights the need for better treatments for migraine sufferers.

Atogepant, sold under the brand name Qulipta by AbbVie, is part of a new class of migraine medications known as CGRP inhibitors, so named because they block a protein called calcitonin gene-related peptide (CGRP). , which has been found to be the cause of migraines.

Qulipta is one of two FDA-approved CGRP inhibitors taken as a pill to prevent migraine headaches, the other being rimegepant, sold as Nurtec by Pfizer. All other drugs in this group that are used to prevent migraines are injections.

The American Headache Society (AHS) recently released a position statement saying that CGRP inhibitors should be the first treatment a doctor prescribes for migraine. But insurance companies often require patients to go through a process known as “step therapy” where they must try less expensive interventions before they can get Qulipta or one of the other inhibitors. of CGRP.

According to Dr. Andrew Charles, “Therapies that target CGRP, unlike many other migraine treatments that are “borrowed” from other symptoms such as antidepressants, blood pressure medications or seizure medications. , professor of Neurology at UCLA and the lead author of the American Headache Society’s position statement.

Step-by-step therapy requires patients to try a series of cheaper drugs first, even if they don’t work well and cause more side effects, before they are allowed to receive one of the new treatments. The goal of step-by-step treatment is to control costs, but it can also end up delaying the right treatment and patients often find it confusing and time-consuming because they have to use more drugs unnecessarily before they can find the one that works. .

“Treatment of steps, or failure of the first need, is a useless situation for people like me who live with migraine. For me, using medicine that was known to be ineffective is delayed necessary treatment, and it has led to worsening disability and chronification of my migraines,” says Nancy Harris Bonk, a migraine sufferer and advocate.

Congress has introduced a bill that would ban interventional treatments if they are no longer safe, which is often the case for migraine sufferers.

“It is not surprising that the cost of medicine is an obstacle for patients to get this treatment despite this position paper, and the main goal for all of us is to reduce the cost of drugs for patients and the system,” Dr. Matthew Robbins, associate professor of Neurology at Weill Cornell and president-elect of AHS, told ABC News. “However, our main goal is to get the right treatments to the right patients, so we hope that the position statement will resonate with insurance companies, drug benefit managers, and institutions. other interventions to improve access include cost reduction for consumers.”

For example, AbbVie offers a program to help with the cost of Qulipta by offering a savings card and a patient assistance program that can reduce out-of-pocket costs for eligible patients, including Medicare and Medicaid.

Pfizer, the makers of Nurtec, offer a similar savings and benefits program but only for those in private insurance plans. People on Medicare and other government-sponsored insurance may end up paying higher out-of-pocket costs.

“Many patients and health care providers are unaware of the patient assistance program offered by Abbvie or other companies. In addition, pharmacies often do not accept co-pay cards or coupons provided by the manufacturer, which leaves many patients without access to the necessary drugs,” said Dr. Hida Nierenburg, a board-certified neurologist and chief operating officer of Nuvance Health.

“Although they are expensive, some insurers now believe that there is enough evidence to support their effectiveness, tolerability and safety that they are considered a first-line treatment for migraine prevention,” say Dr. Charles.

Keerthana Kumar, MD, MPH, a licensed neurologist at Nuvance Health / Vassar Brothers Medical Center, is a member of the ABC News Medical Unit.