Join Tom Kerr as he interviews Nikki Wilson, Senior Director of Clinical Pharmacy Services to dig into part one of our annual drug trends series. In this short video they’ll discuss standout trends from our most recent data focusing on migraine medications.
Tom Kerr (TK): Hello, and thanks for joining us as we take a deeper dive into our annual drug trends report. I'm Tom Kerr, and today we'll be highlighting a top trend from the data we observed within all calendar year retail and mail order transactions billed through Enlyte Pharmacy Solutions in 2023 and 2024. Joining me today, as always, is Nikki Wilson, Senior Director, Clinical Pharmacy Services.
TK: Hey Nikki. Thanks for joining us.
Nikki Wilson (NW): Hi, TK. Happy to be here today. Excited to get started.
TK: Alright. So let's get started. Can you give us a brief overview of what stood out in this year's report?
NW: Yeah. So overall, utilization and cost per claim were down across all the therapeutic categories in 2024, in that top ten that we normally carve out ranked by cost.
NW: However, cost per script was up. And so we're looking at some rising costs in the industry and in the space. It's been a big area of focus across the regulatory space as well. And to particular, what we saw in the trends were two therapeutic categories that fall in that top ten therapeutic category ranking by cost that rose by roughly 10%.
NW: Topicals was one of them. Those were up 10.5%, and the other was migraine medications. They're really bucking those trends. And so focusing even further on that migraine category in particular and their cost rankings in 2024, we wondered, of course, what specific medications are driving those trends in the retail and mail order channels that we analyze typically in part one of our drug trends report.
NW: So utilization of the newer, more expensive migraine treatments continued to grow, driving up that overall spending in that therapeutic area. Those calcitonin gene related peptide inhibitors, that newer class, those CGRPs, in particular, inhibitors, that newer class, those CGRPs, in particular, saw significant uptake. And those top three migraine meds by cost fall within this type, Nurtec ODT, Ubrelvy, Qulipta.
NW: Traditional generic migraine medications such as the triptans, those remained widely used due to their lower cost compared to the branded options. However, prices for some of those generics did increase as well. So the total migraine medication cost per script rose about 9.7% compared to the previous year, outpacing the average increase across all those other drug categories within the top ten ranked by cost, as I mentioned, with the exception of topicals. And that is just really pointing again to the fact that we need to continue to watch that category. It remains a high impact area, and migraine meds spending remains something we should watch. So within with 2024 characterized by the growing use of those high cost branded treatments, which can be tempered by certain payer management strategies, The focus really is gonna need to be balancing access to those and affordability as an ongoing priority.
TK: Yeah. And I understand some of the top three migraine medications are injectables. How do they fit into our specialty drug category?
NW: Yeah. That's right. So, those newer CGRPs include a number of injectable treatments.
NW: And just as a reminder, as far as how specialty category is set up, there's no universal use universal list of specialty drugs. So we're not able to very easily identify that group, but it's typically lower volume, high cost medications, generally, treating rare complex conditions, maybe special storage and handling requirements, various clinical applications that need to be considered for use, administration challenges. So we've got our defined list. And, several of those medications that I just mentioned in the CGRP class, we look at how they how they fit into disease state buckets as well as by therapeutic category.
NW: And of note, in 2024, that migraine category, including several of those injectable migraine meds such as Ajovy, Emgality, Aimovig, which have about an average cost of just under $800, per month for the script, those tended to be in that top five therapeutic categories. We ranked by cost within the specialty group as well. So migraines came in, at number five spot by percent of specialty category cost, and, again, driven primarily by those newer CGRPs for the prevention and acute treatment of migraine headaches in adults. But one thing that really stood out in that specific carve out of the category is that category jumped considerably more than all others, increasing nearly sixfold.
NW: So it moved into that top five spot, nearly a six times increase in specialty migraine scripts per claim. So big utilization increase leading to a higher dollar amount. And because of that very low volume, we saw some big impacts there. So that six fold increase was really just ten more scripts in in 2024, but it led to almost a $6000 more, bump in spend. So big impact because it's low volumes. We're continuing to monitor those and make sure treatment's appropriate.
TK: Nikki, what happened with the metrics for migraine medications when out-of-network retrospectively managed data was included, like, in part two of our drug trends report?
NW: Yeah. Sure. So part two looks more at the aggregate view, the total view of pharmacy. So it's looking at that combined in network retail and mail order and out-of-network data.
NW: And what we saw there was migraines actually dropped to number eight by rank and cost. They were number seven when you looked at in network only. Interestingly, topicals, the other category I keep calling out that's really followed suit with migraines, those moved to the number one spot by cost where they were number four in network. So pulling in those additional, metrics that we might be seeing in the out of network space that aren't traditionally captured or reported upon, by a PBM, you can see some notable changes in things that we need to be watching.
NW: Other movements that changed within that space for migraines as far as scripts per claim and cost per claim. We saw again that there was a big utilization increase within the migraine medication class. It jumped 21.6% when we looked at combined data, and the only decrease was in that opioid class within that top ten going down by 1.4%. So some hifts there, and cost per claim for migraine meds jumped about 27.3% in 2024, driven primarily by, both utilization and cost per script increases.
TK: Great. Well, thanks to Nikki Wilson for joining us, and thank you all for coming today. And stay tuned for more drug trends analysis as we continue to produce content throughout the year.