The report examines migraine medications as a potential cost driver in California Workers’ Comp

Migraine drugs make up a small percentage of prescriptions for injured workers in California, but they account for a larger share of workers’ compensation drug payments, a new report shows.

Less than 1% of all prescriptions issued to injured workers in California in 2023 were migraine medications. Still, these drugs consumed 4.7 percent of workers’ compensation drug payments, a nearly eightfold increase from 2018, according to a study by the California Workers’ Compensation Institute, which ties to the rise of brand-name drugs with high costs not listed in Use of medical treatment. Program (MTUS) Form.

Migraine, a neurological disorder characterized by severe headaches often accompanied by nausea, dizziness, and sensitivity to light and sound, is not a common work injury but is common in the general population. Migraine diagnoses are based on the patient’s symptoms, personal and family history, and exposure to triggers.

In recent years, the use of migraine medications has increased as new pain relief and preventive medications have been approved and come to market, according to the CWCI study. Migraine drugs accounted for 0.7 percent of California workers’ compensation prescriptions filled in 2023, up from 0.2 percent in 2018.

This growth, the continued evolution of the migraine drug market, and the increasing use of more high-cost brand-name drugs for which there are no generic equivalents drove migraine drugs’ share of workers’ compensation spending from 0.6% in 2018 to 4.7% last year, according to the CWCI.

The study uses data on more than 9.5 million California workers’ compensation prescriptions filled between 2010 and 2023.

It found that the top two migraine medications prescribed in 2023 were the relatively inexpensive sumatriptan (such as Imitrex) and rizatriptan benzoate (Maxalt), but from 2018 to 2023, the share of these medications in workers’ migraine medication prescriptions decreased from 75.6% to 52.3. % while their share of migraine drug spending fell from 38.0% to 5.5%.

During the same period, the CWCI study identified six cost-leading FDA-approved migraine drugs introduced into the system that are not drugs listed on the MTUS Formulary:

• The auto-injector Aimovig (Erenumab-aooe) accounted for 23.4% of migraine drug spending by California workers, and by 2021 accounted for 8.8% of migraine drug prescriptions. With new drugs coming online, it dropped to 5.7% of migraine prescriptions by 2023, but with an average payment of $708 per prescription, Aimovig still consumed 6.7% of migraine drug spending.
• Ajovy (Fremanezumab-vfrm) by 2020 accounted for 3.5% of California workers’ migraine prescriptions, but at an average of $617 per prescription, it accounted for 8.6% of migraine drug dollars. By 2023, Ajovy had risen to 4.6% of migraine prescriptions and the average payment had risen to $817, but with the introduction of higher-cost alternatives, its share of migraine drug spending fell to 6.7 %.
• Emgality (Galcanezumab-gnlm) by 2020 accounted for 4.3% of migraine prescriptions and with average reimbursements of $667 consumed 11.5% of migraine drug payments. As non-injectable options came on the market, Emgality’s share of prescriptions fell to 2.6% by 2023, but payments averaged $649, so it still accounted for 2.8% of drug spending for migraine.
• Ubrelvy (Ubrogepant) became the first oral gepant approved in December 2019 for acute migraine pain and other symptoms, but it was not indicated as a preventive treatment. By 2021, Ubrelvy accounted for 4.4% of workers’ migraine prescriptions, but with an average payment of $1,426 it accounted for 17.2% of migraine drug payments. Ubrelvy’s share of migraine prescriptions rose to 7.0% last year, although the average paid fluctuated with the average number of tablets dispensed, so that in 2023 the average payment was $1,507, while its share of migraine dollars was 17.4%.
• Nurtec ODT (Rimegepant Sulfate) in 2021 accounted for 3.7% of workers’ migraine prescriptions and, with average payments of $1,277, accounted for 12.8% of migraine drug spending. Nurtec’s share of prescriptions increased to 9.4% in 2022, then 15.0% in 2023, while average payments rose steadily to $1,675 in 2023, bringing its share of migraine dollars to 41.6 %, making it the fastest-growing migraine medicine among California workers. ‘ comp, both in terms of usage and payments.
• Workers’ compensation prescriptions for Qulipta (Atogepant) first appeared in significant volume in 2023. By the end of 2023, they accounted for 3.1% of migraine prescriptions filled last year, and with an average reimbursement of $1,106 per prescription, consumed 5.7% of migraine drug spending in 2023. Qulipta’s arrival in workers’ compensation coincided with declines in the three injectable monoclonal antibodies (Aimovig, Ajovy and Emgality), which together fell from 16.2% of migraine drug prescriptions in 2022 to 12.9% in 2023, while their share of Migraine Drug Expenditures fell from 24.4% to 16.2%, signaling continued change within this drug group .

Migraine drugs did not rank among the top 10 drug groups in California workers’ compensation a decade ago, but now rank sixth in total payments, with aggregate spending approaching that of opioids and exceeding that of antidepressants and musculoskeletal medications, according to the CWCI. .

CWCI published more details and analysis on these drugs in a Spotlight report, Trends in the Utilization and Reimbursement of Migraine Drugs in California Workers’ Compensation. Institute members and subscribers can login to the CWCI website and access the report from the Research tab, others can purchase it from the CWCI online store.

TOPICS
California Workers’ Compensation Personal Auto