CGRP Monoclonal Antibodies: cost, access and coverage
Disclaimer: this information is provided as a general overview of a complex topic. It can be hard to know which medicines you would have to pay for yourself. There might also be changes in Patient Support Programs and this information may become outdated. Ask your insurance or Patient Support Program for any specific question.
Bringing this article to your doctor may help your conversation.
What is the cost of CGRP antibodies?
- Aimovig (70 and 140 mg are the same cost): 535 $ per dose
- Emgality 120 mg: 623 $ per dose
- Ajovy 225 mg: to be determined in 2020
Remember that the final cost will include the cost of the drug and also pharmacy fees.
Are CGRP antibodies covered by public insurance?
Public insurers have not decided yet, and each province may be different. INESSS (Quebec) and CADTH (rest of Canada) are looking at research results before making a recommendation. Migraine Canada has provided a patient report to INESSS and CADTH on Aimovig (erenumab) and will provide reports on every new drug available.
Stay tuned to participate in our surveys!
Are CGRP antibodies covered by private drug plans?
Yes, some drug plans will reimburse CGRP antibodies, completely or partially. Talk to your insurance company about your plan and get the forms for your doctor to fill in.
Can I predict if my drug plan will cover CGRP antibodies?
Most private plans will cover CGRP antibodies if:
- You have tried and failed or not tolerated at least 2 medications for migraine prevention. See our list of preventives
- You have 8 or more migraine days per month (4 weeks)
Can I pay for a CGRP antibody out of pocket?
Yes, you can, but it would be expensive. Some people with migraine may decide to pay themselves if they do not fit the insurance criteria for example:
- Having 6 days with migraine, but these days are disabling
- Not having tried 2 preventives
How can I access the pharmaceutical companies’ Patient Support Programs?
- Aimovig GO is the support program from Novartis.
- Lilly Plus is the support program from Eli Lilly
- The Ajovy support program (Teva) will be announced in 2020.
You cannot contact the Patient Support Program by yourself. Your doctor has to prescribe the CGRP antibody to you and fill in a form. You will need to consent to the program and sign the form. Providing a list of the preventive medications you have tried before with the doses, how long you tried them, and the result will be very helpful for your physician.
Do I have to see a neurologist to get a CGRP antibody prescription?
No. Officially, the doctor prescribing the CGRP antibody must be “experienced in the treatment of migraine.” There is NO official requirement for a specialist. Many family doctors are competent to treat migraine. Of course, not all family doctors will feel comfortable with a new and costly drug. This will be a learning curve.
How can I monitor the frequency of my migraines?
Knowing how often you have headaches is important. Consider using a headache diary to count days where you feel migraines. You could use a paper calendar or a smartphone app such as the Canadian Migraine Tracker.
How long will the antibody be covered by the Patient Support Program?
Usually, until your insurance company has made a decision regarding coverage. Then, you will switch from to the insurance company. You may have to pay part of the price. Some Patient Support Programs provide a co-pay, which means that they will cover the cost that your insurance does not cover (for example, 80% paid by your insurance, 20% paid by the PSP). Changing to your insurance company will require more forms to fill in carefully.
Note: the rules of the PSPs may change. Always check with the program for the most recent information.
Can I combine CGRP antibodies with Botox?
Medically, yes. Insurance companies are trying to decline the combination. They will argue that antibodies have not been tested in combination with Botox, which is true, but the main reason is probably cost.
Here are a few arguments supporting the combination of Botox and CGRP MABs:
- Combining medications with different mechanisms to optimize the treatment of a disease is very common in medicine.
- There no theoretical risk to combining Botox and CGRP MABs.
- There are scientific arguments supporting this combination. Botox and CGRP do not act on the same nerve fibers and in theory they could work well together. Botox also inhibits the release of other peptides, not only CGRP.
- Some patients with chronic migraine who get a partial benefit from Botox have seen an additional benefit when adding an antibody. Evidence is being collected.
One argument against the combination of Botox and antibodies is the cost. Is that reasonable?
The combined cost of Botox and CGRP antibodies per year is less than $ 15 000. That may sound expensive, but other diseases are treated with more expensive therapies. Drugs for multiple sclerosis cost over 20 to 40 000$ per year. Considering the fact that migraine is disabling (especially Chronic Migraine), cost-effectiveness should be analyzed before declining co-therapy. How much is the ability to live your life worth?
Hopefully we will have more research on this soon. Do not let your insurance company make medical decisions. Hopefully patients and doctors can unite to improve access to the best options.
If I am doing much better, and do not have 8 days of migraine per month anymore, could the insurance company decide to stop paying for the CGRP antibodies?
The use of “stopping rules” have been seen in the US and in some provinces with Botox.
From a medical perspective, this does not make sense. For example, if someone takes a pill for blood pressure, and the blood pressure gets better, that is a success and the medication should be continued. The same applies for epilepsy, diabetes, thyroid disease. Insurance companies may try to find ways to stop coverage, but the first priority should be the quality of life of patients.
Still, if I am doing really well, could it be reasonable to stop the CGRP antibodies? Will I get rebound migraines?
It may be reasonable to go longer between injections if you are doing much better. Since the antibodies will be cleared gradually from your blood, you should not see bad rebound migraines. They may come back slowly. If that happens the medication could be restarted. For more about the length of preventive therapy in migraine read here (See this post).
Other associations are also providing information on CGRP Antibodies:
- CGRP-Blocking Antibodies: Q&A With Dr. David Dodick
- What to Know About the New Anti CGRP Migraine Treatment Options
An excellent summary article has been written by Dr Stewart Tepper:
Tepper SJ. History and Review of anti-Calcitonin Gene-Related Peptide (CGRP) Therapies: From Translational Research to Treatment. Headache. 2018;58 Suppl 3:238-75.
A full reference list for CGRP antibody trials and clinical evidence can be found here (PDF CGRP references).
THE MIGRAINE TREE
- ACUTE TREATMENTS
- DEVICES AND NEUROMULATIOIN
- PREVENTIVE TREATMENTS
- PROCEDURES AND INJECTIONS
- SELF-CARE AND LIFESTYLE
- SOCIAL LIFE