Lost work days and time spent in emergency rooms should have weighed more heavily in an analysis of migraine medicines by an influential advisory board, advocates said. The Institute for Clinical and Economic Review, a nonprofit that analyzes whether a drug’s outcome for patients justifies its price tag, can sway insurers’ decisions on drug coverage. It recently determined that Allergan’s Ubrelvy, Eli Lilly’s Reyvow, and rimegepant—a Biohaven drug still being considered for approval by the FDA—aren’t superior to older, cheaper drugs already on the market.
That provoked pushback from patient advocates who want coverage for as many drugs as possible at a time when governments look for options to lower costs and drug companies fight to get their products into patients’ medicine cabinets.
Patient groups like the Coalition For Headache And Migraine Patients (CHAMP) and the Headache and Migraine Policy Forum—which both list Allergan and Eli Lilly as sponsors—argue the analysis of each drug’s value didn’t take into account the “large hidden cost” of migraines on society—like worker absenteeism or inappropriate opioids prescriptions during emergency room visits, Lindsay Videnieks, executive director of the Headache and Migraine Policy Forum, said.
“Waiting is painful for migraine patients,” Videnieks said. Any instance where someone with migraine attacks has to wait for treatment is an issue, she said.
That’s why she and Kevin Lenaburg, CHAMP’s executive director, are pushing insurers to use “reasonable prior authorization” for these drugs.
Doctors could just check a box on a form that said their patient had tried other options rather than a more arduous testing process, they said.
Although ICER isn’t directly connected to insurers, states, or the federal government, it has grown increasingly powerful in the past five years. Insurers, drugmakers, and state governments listen to its suggestions and sometimes use them in policy decisions, David Whitrap, ICER’s vice president of communications and outreach, said.
“We’ve actually had instances specifically in the migraine space where both insurers have broadened access because of our research and manufacturers have lowered the price because of our research,” Whitrap said. He’s referring to the 2018 analysis ICER did for migraine prevention drugs from Teva, Eli Lilly, and Amgen.