Drug Trends Analysis

Hey, it's Nikki Wilson, Doctor of Pharmacy and Senior Director of Clinical Pharmacy Services at Enlyte. So we just published our first release of drug trends, I wanted to dive into a couple of highlights, mainly around the migraine medication trend that we continue to see on the rise. So this report was in network data only across our entire book of business. It was comparing the year twenty twenty five with the year previous, And what we saw continue is that overall cost and utilization by claim across the entire drug category set was down compared with the year previous. However, migraine costs rose by nearly ten percent for cost per script across retail and mailer channels in twenty twenty five. Migraine utilization also rose by nearly ten percent. So that double whammy of more scripts and costlier scripts has led for that to be one of the top trending categories over the last couple of years. So what's behind the trend? Migraine is prevalent. It's the second leading cause of disability worldwide. It's number one if you look at disability in individuals younger than fifty years old, and it affects about forty percent of the population. You probably know somebody that suffers from migraines, or maybe it's you yourself. It's really common. It's in fact the sixth most prevalent disease worldwide. And so knowing that this is a diagnosis many of us carry, now it's time to consider the cause factors. Drug manufacturers realized that there was a need for new and better treatments and developed the first CGRP inhibitors, calcitonin gene related peptide inhibitors, back in May of twenty eighteen. We saw our first FDA approval. Why are these different? How do they work? So they were new in the way that they affected migraine headache complaints. They decreased the level of calcitonin gene related present during a migraine attack, which those levels have been shown to be correlated with the intensity of headache pain and is something that's released when one of those attacks is in place. So we have a number of products on the market. Since they're newer, they're all brand medications and carry a pretty hefty price tag, but there's a number of options for both acute and preventative treatment of migraine today. So in fact, that category, CGRPs, the pricing ranges from about nine seventy dollars to two thousand dollars average wholesale price per script for a one month supply. The average cost that we see associated with those drugs is about twelve hundred dollars per month. And in fact, we saw migraine medication break into that top ten therapeutic classes by Spend in twenty twenty two. And that's just continued to be the case over the last several years. This last year, they were at number six by Spend. The three top three leading meds in that category are all brand oral medications for migraine prevention and treatment. Nurtec ODT with an average wholesale price per script of two thousand and thirty seven dollars Ubrellvi at seventeen ten dollars and Qlipta at fourteen forty six The specialty category also includes four injectable or infusion, IV infusion products that are in the CGRP category. They're on the market for preventative treatment of migraine only, and those are Emgality, Aimovig, and Viupti. And so those are currently driving spend in that category as well, but they're a good option for preventative treatment. I do want to point out there's still a number of other options on the market, many available as generics that are still very tried and true and have good evidence for efficacy. But these newer classes are being reached for more and more by prescribers and patients based on their ability to control migraine frequency and pain. So they, there's something to take a look at. So recommendations for your program, look at the prevalence of migraine medications in your book. Two things I always recommend for this category of meds is confirm you have a true diagnosis of migraine. There's a number of criteria that need to be met in order for it to be considered true migraine and not just a headache. And these drugs are only appropriate for migraine complaints. That criteria can be found in the official disability guidelines, which is unique to the workers' comp space and a number of other resources. And then number two, look at causation, look at work relatedness and ensure that given the prevalence of this disease state, that there is a tie to that work related incident. So that is it for this session. And I'm looking forward to diving into a full view of pharmacy trends in our next release, which we'll look at in and out of network. So I'll see you then.