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CGRP antibody access and coverage in Canada in April 2020

CGRP antibodies are a new class of Migraine

<span style="font-weight: 400;">A migraine is a powerful headache that often happens with nausea, vomiting, and sensitivity to light. Migraines can last from 4 hours to 3 days, and sometimes longer.Most people start having migraine headaches between ages 10 and 40. But many women find that their migraines improve or disappear after age 50.</span><i><span style="font-weight: 400;">Référence : webmd.com, </span></i><i><span style="font-weight: 400;">https://www.webmd.com/migraines-headaches/migraines-headaches-migraines#1</span></i><i><span style="font-weight: 400;">  consulted on july 4</span></i><i><span style="font-weight: 400;">th</span></i><i><span style="font-weight: 400;">,2019.</span></i>
" >migraine [1] preventives. (See this post [2]). These drugs are more expensive than oral preventives. The cost charged to a patient includes the cost of the medication AND the pharmacy fees (variable from one pharmacy to the other).

There are two main categories of medication insurance: public and private.

Private insurers make their own decisions. Some private payers have decided to cover CGRP antibodies, usually with clinical criteria (headache frequency, previous medication failure).

Public insurers (usually linked to provincial Health Ministries) make decisions based on recommendations by an agency called CADTH [3]. The recommendation from CADTH on erenumab is still pending and will most likely set a precedent for other antibodies coming to the Canadian market in the future. 

Pharmaceutical companies frequently offer Patient Support Programs (PSP).

These programs usually include financial support, often to offer a bridge until the patient’s insurance takes over reimbursement of the medication. The following text describes the current situation for coverage and Patient Support Programs for CGRP antibodies in Canada, to the best of our knowledge. Be aware that the situation may change rapidly.

General criteria for PSP financial assistance and private plan coverage (may vary from one company to the other):

Aimovig (erenumab)

The cost is the same ($532 CAD+ pharmacy fees) for the 70 mg and the 140 mg dose.

Patients with private insurance:

Patients with public insurance:

Patients treated with Botox:

The Aimovig GO program offers information, injection training, reimbursement support and financial assistance for all patients using Aimovig.

To apply for reimbursement of Aimovig before public coverage, your health care provider could fill a special form to get Aimovig covered as an exception drug. This process varies from one province to the other and success is also variable.

Emgality (galcanezumab)  

The cost of one dose is $623 CAD + pharmacy fee.

Private AND Public insurance patients:

Patients treated with Botox:

More information on private drug plans covering Emgality should be available in the future.

To read more on the Botox/ CGRP MAB combination see here [6].

Ajovy (fremanezumab)

Ajovy has been approved by Health Canada as of April 9th 2020. This means that the product should be available to patients over the next few months.

At present time, there is no information available on the Patient Support Program that will be provided by Teva for patients who will use Ajovy.

The CADTH process on Ajovy has been initiated. Migraine Canada is currently working on a patient submission.

Vyepti (eptinezumab, U.S. name)

This medication is now managed by the company Lundbeck. It seems probable that the drug will be submitted to Health Canada, but there is no estimate regarding when it would be available to Canadian patients.

Migraine Canada is dedicated to advocating on your behalf for access to care.

Migraine Canada will be involved as a patient association in the CADTH review process for every medication relevant to people with migraine and headache disorders.

If you have concerns regarding public reimbursement of migraine medications in your province, we encourage you to reach out to your local elected representative or Minister of Health.

If you have concerns about private coverage of medications, we encourage you to talk to your insurance provider and your employer (human resources department).

Please contribute by keeping in touch with us on social media and participating to surveys.

Please send questions to info@migrainecanada.org [7]