Top migraine medication effective for preventing migraines, treating drug-induced headaches is hard to access

The FDA-approved oral migraine drug Atogepant, marketed as Qulipta by AbbVie, has been found to be effective in treating “medication overuse headaches” caused by excessive use of other pain relievers. However, obtaining insurance coverage for Qulipta is often a complex process for patients.

Migraines are a significant health issue, affecting approximately one in eight adults in the United States, making it the leading cause of disability in adults under 50. With such a high prevalence, there is a clear need for effective treatments for migraine sufferers.

Atogepant belongs to a new class of migraine medications known as CGRP inhibitors, which work by blocking a protein called calcitonin gene-related peptide (CGRP), linked to migraine triggers. Qulipta is one of only two FDA-approved CGRP inhibitors available as a pill for migraine prevention, the other being rimegepant (Nurtec by Pfizer). All other CGRP inhibitors for migraine prevention are injectables.

The American Headache Society (AHS) recommends that CGRP inhibitors should be the first treatment a doctor prescribes for migraines. However, insurance companies often require patients to go through a process known as “step therapy,” where they must try less expensive interventions before gaining access to Qulipta or other CGRP inhibitors. This process can delay proper treatment and is frustrating for patients.

Congress has proposed a bill that could potentially ban step therapy when it is unsafe, which is often the case for migraine patients. Both AbbVie and Pfizer offer patient assistance programs to help with the cost of their respective medications. However, many patients and healthcare providers are unaware of these programs, and pharmacies may not accept manufacturer-offered co-pay cards or coupons, leaving some patients without access to necessary medications.

Despite the high cost of CGRP inhibitors, there is growing recognition of their efficacy, tolerability, and safety, leading some insurers to consider them as a first-line treatment for migraine prevention.

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