By: Jaime Sanders
I am a mother, wife, and patient advocate living with intractable migraine. I am allergic to or do not tolerate many standard migraine treatments, and the pain management options I am left with are extremely limited. Despite a comprehensive strategy to manage my migraine and taking four preventative medications, I am in pain every, single day. Living with migraine disease carries a huge burden. It has forced me to leave the work force and my husband and children to be caregivers.
When I hear of novel treatments in development, like the recent approval of therapies called gepants, I am hopeful but cautious. I have been in this world long enough to know that as soon as a new drug is approved, payers will begin looking at their wallets and turn to third parties like the Institute for Clinical and Economic Review (ICER) for reasons they need not cover the drugs or should implement burdensome and harmful prior authorization strategies. In this instance - though I have serious concerns with ICER’s methodology that devalues my life as someone living with a chronic condition - I was heartened it found two of these new migraine treatments to be cost-effective. I am, however, simultaneously concerned that its recommendations to payers overtly recommend they use burdensome prior authorization criteria, which will lead to delays and barriers for patient access.
Migraine has been synonymous with my life since I can remember. At the age of eight, I was formally diagnosed and put on propranolol for prevention. I was on that medication for five years, but it never worked. At that early age, I learned that migraine is a capricious disease that is difficult to effectively treat. For this reason, it is vital to have good neurologists and headache specialists that know you and your migraine disease, and it is equally important that they are able to do their jobs and prescribe the treatment plan they know is best for their patients without forcing us to try numerous drugs that will not work. Migraine is a progressive disease, and delays lead to more costly migraine attacks and chronification. I know this personally.
Most of my life with migraine I was episodic, experiencing 3-10 migraine attacks per month with 1-2 being extremely severe. Then during my third pregnancy, something changed. My first trimester I had a three-month long migraine attack. At the time, I was working full-time, going to school at night, and had a three-year old and a nine-month old at home. Being in pain every single day was exhausting. I assumed I had a brain tumor. After an MRI that came back clear, the conclusion was that it was a migraine that would not go away due to hormones and the pregnancy. After that, the attacks became more severe and lasted longer.
I worked with my doctors and tried every treatment. Over the counter medications didn’t help, and I quickly found that I could not tolerate triptans. I tried several prevention medications, which would work for short periods of time before becoming ineffective.
My story is far too common. Patients like me should immediately access new treatments. To ensure this happens, it is vital that doctors’ assessments be widely accepted in determining which patients have failed or can’t use older medicines. Migraine disease is an incredibly personal journey and the clinician-patient relationship should be primary, not the academics over at ICER or their recommendations for prior authorization, in making treatment decisions.