Personalized treatments are helping acute migraine patients. ICER says they’re not worth the cost.

Personalized treatments are helping acute migraine patients. ICER says they’re not worth the cost.

Migraine, especially acute migraine, can be severe and devastating.   

“I know firsthand that migraine attacks are debilitating not just for me, but for my entire family,” Kristin Molacek, a mother of five young children and migraine patient in Springfield, Missouri, shared with the Headache & Migraine Policy Forum.

More than 36 million Americans are living with migraine, and although the chronic condition can affect anyone, women are 3 times more likely to suffer than men, according to the American Migraine Foundation

“Women experience migraine differently than men,” explains the Migraine Research Foundation. “Women report episodic pain (often for a longer duration) and chronic pain more frequently than men.”

Migraine: It’s Not Just a Headache!

It may seem obvious that migraine is painful, but it has been a long struggle for full acknowledgement of what migraine patients are going through. 

“For years, migraine patients were told, ‘It’s just a headache,’” explains Terry Wilcox, executive director at Patients Rising, a national patient advocacy non-profit organization. “It’s not just a headache. It’s devastating.” 

She adds,“Now, the medical community universally acknowledges the devastating pain of migraine, and we’ve seen incredible innovation with personalized treatment plans developed for each patient.”

Researchers are discovering more about how DNA and RNA affect a patient’s responsiveness to treatment, according to a 2019 article published in The Journal of Headache and Pain. New treatments also mean options for patients, such as those  experiencing vascular disease, uncontrolled hypertension, or hemiplegic, who cannot safely use triptans, the most common acute migraine treatment. 

“Treating acute migraine is challenging because of substantial rates of nonresponse to medications and difficulty in predicting individual response to a specific agent or dose,” Dr. Benjamin Gilmore of the David Geffen School of Medicine at UCLA and Dr. Magdalena Michael of the Mountain Area Health Education Center write in a 2011 article in the journal American Family Physician.  

 Acute Migraine: Debilitating Pain

Migraine

With new treatments, doctors are offering personalized care to patients who have spent years struggling with ineffective medications. In Kristin’s case, that personalized treatment breakthrough came when she participated in a clinical trial.

“I was lucky to be included in a clinical trial for a new migraine therapy that significantly reduced my migraine attacks and had minimal side effects,” she says. “Even more important, it allowed me to care for my family and be there for the important things – like birthday parties and school programs.”

The new acute migraine therapy that helped Kristin received F.D.A. approval in December as the first and only oral CGRP receptor antagonist for the acute treatment of migraine. 

“Ubrelvy represents an important new option for the acute treatment of migraine in adults, as it is the first drug in its class approved for this indication,” Dr. Billy Dunn, M.D., acting director of the Office of Neuroscience in the FDA’s Center for Drug Evaluation and Research, said in a statement. “The FDA is pleased to approve a novel treatment for patients suffering from migraine and will continue to work with stakeholders to promote the development of new safe and effective migraine therapies.”

Other migraine patients are finding success with two additional treatment innovations, lasmiditan and rimegepant. Yet, despite F.D.A. approval, many patients will be blocked from accessing the acute migraine innovations. 

ICER Report: Substantial Net Health Benefit from New Treatments

ICER Acute Migraine Report

Patient advocates are worried that a new report issued by the Institute for Clinical and Economic Review will be used by insurance companies and pharmacy benefit managers to deny patients access to the three new acute migraine treatment innovations. 

In January, ICER released its “Evidence Report on Acute Treatments for Migraine,” which encourages insurance companies to block patients from accessing the new treatments based on the organization’s controversial cost algorithm.

“Most patients have never heard of ICER,” explains Wilcox of Patients Rising, “But, ICER can affect whether patients will be able to access the treatments prescribed by their doctors.”

The science shows clear medical benefits for patients, a fact even ICER’s report recognizes. 

“This evidence provides moderate certainty that all three treatments offer a small or substantial net health benefit, with high certainty of at least a small net health benefit,” the organization stated in its January 2020 assessment

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