1. What is the decision or change (e.g., clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
Many insurance pharmacy and therapeutic committees include formulary restrictions on concomitant use of therapies for migraine patients. We are interested in cost benefit analysis of patients who are able to use innovative therapies such as CGRP inhibitors or gepants, for example, and neurotoxins in combination. Combination therapy has been shown to reduce the number of headache days for migraine patients, who are the fourth highest users of emergency room services. Increasing combination therapy can help reduce attacks and drive down healthcare costs.
2. Why are you struggling with this issue? Commercial insurers have long considered concomitant therapy to be "investigational" even though providers have provided real world evidence showing that patients using a combination of therapies have reduced numbers of headache days and migraine attacks.
Migraine is a hereditary neurological disease that affects both the mind and the body. It is more than “just a headache” – there exists a substantial systemic impact, both in severity and duration, to the patient. The pain of a migraine attack, especially compared to other medical conditions, can be debilitating. Additionally, migraine negatively impacts patients’ ability to function and increases the likelihood of other comorbidities such as anxiety and depression. Even if not fatal, migraine robs many patients of a meaningful quality of life. Persons living with migraine disease have long used therapies in combination, including triptans and other off-label usage of medicines to treat migraine attacks. It is unclear why insurers are restricting the use of combination therapy for migraine patients.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
We would like to see commercial payers change formulary coverage policy on combination therapy. HMPF will review commercial claims data on this topic.
4. When do you need the evidence report?
Friday, 11/03/2023
5. What will you do with the evidence report?
HMPF will utilize this report to help inform stakeholders including screening initiatives such as the Women's Preventive Services Initiative (WPSI) as well as medical societies such as the National Headache Foundation, the American Academy of Neurology, and the American Headache Society. We will also amplify the report with insurance commissioners, payers, and policymakers.
Supporting Documentation
Survey Report - Combination Therapy for Migraine (PDF, 2 MB)
Optional Information About You
What is your role or perspective? Migraine Community Coalition
If you are you making a suggestion on behalf of an organization, please state the name of the organization. The Headache and Migraine Policy Forum
May we contact you if we have questions about your nomination? Yes
