by Jane Anderson
New oral medications for
acute migraine — one pending launch and two more that could be approved in the
coming months — likely won't shake up formulary coverage for a condition that's
largely treated by generic triptan medications, pharmacy benefit experts say.
Eli Lilly and Co. on Oct.
11 received FDA approval for its drug Reyvow (lasmiditan), an oral medication
that's the first serotonin (5-HT)1F receptor agonist to be approved for
migraine. Meanwhile, Allergan on Nov. 19 said it's on track for December FDA
consideration of ubrogepant, an oral CGRP receptor antagonist for acute
migraine. Biohaven Pharmaceuticals also has applied for FDA approval on its
oral CGRP antagonist rimegepant.
Mesfin Tegenu, R.Ph.,
president of PerformRx, doesn't expect widespread uptake of Reyvow. "The
launch of lasmiditan will likely not change the formulary status quo when it
hits the market, as it most likely will become a niche medication for patients
inadequately controlled on triptans, or for those who cannot take triptans,"
Tegenu tells AIS Health. "This is primarily due to warnings on the label
for driving impairment and central nervous system depression."
PBMs could have the
chance to consider how to handle Reyvow and ubrogepant soon, although it's not
clear how soon. Eli Lilly hasn't yet set a launch date for Reyvow, while
Allergan said it expects ubrogepant to be the first approved oral CGRP receptor
antagonist for the acute treatment of migraine.
"As with any new
product, [ubrogepant] will need to be analyzed as part of the class of drugs
for this indication," Tegenu says. "Since this is the first oral
version of a CGRP antagonist, it does have some administration advantages over
injectable products."
Payers can implement
utilization management programs that direct use of these new drugs to those who
have failed or cannot tolerate triptans, says Nicole Kjesbo, principal clinical
program pharmacist with Prime Therapeutics LLC. "Additionally, payers will
consider exclusion strategies and potentially value-based contracts as a means
to manage cost and appropriate therapy," she says.
From RADAR on Drug Benefits
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