Market Outlook

With four anti-CGRP-targeted MAbs (e.g., Amgen/Novartis’s Aimovig, Teva’s fremanezumab, Eli Lilly’s galcanezumab, and Alder’s eptinezumab) and a novel small molecule (Allergan’s atogepant) expected to launch for the treatment of migraine prevention by 2022, the costs of prescription therapy for migraine prophylaxis could surge. With this research, DRG will assess how U.S. physicians and payers alike will react to new, premium-priced brands entering a mostly generic market.


  • What strategies will payers use to control rising costs in migraine prophylaxis, especially as the first MAbs launch in the pain space? How will these restrictions impact neurologists’ prescribing practices? How will coverage compare with Botox?
  • What pharmacoeconomic data will payers find most compelling in evaluating novel anti-CGRP therapies? What efficacy end points will best demonstrate the value of new prophylactics, and what secondary end points will support a reduction of downstream medical costs? What other end points (e.g., improved compliance, monitoring costs) might resonate with MCO managers?
  • How may coverage on commercial plans vary by price points? What major differences in coverage might be expected between commercial and Medicare plans? What discounts do payers expect to negotiate off of WAC prices, on average?
  • How will route and frequency of administration impact neurologists’ use of the drugs and affect coverage by MCOs? What will the prescribing landscape look like in three years, assuming all four anti-CGRPMAbs are available?
  • What points of differentiation are/will be most compelling to neurologists and most convincing to payers?


Access & Reimbursement provides in-depth insight regarding the impact of payer policy on physician prescribing behavior so you can build your market access strategy and optimize your brand positioning.

Markets covered: United States

Primary research:

  • Survey of 100 U.S. neurologists
  • Survey of 30 U.S. managed care organizations (MCOs) pharmacy and medical directors (PDs/MDs)

Key companies: Amgen, Novartis, Teva, Eli Lilly, Alder Biopharmaceuticals, Allergan, Janssen

Key drugs: Aimovig (erenumab), fremanezumab, galcanezumab, eptinezumab, atogepant, Botox, topiramate, propranolol, amitriptyline, others

Content highlights:

  • Reimbursement and contracting.
  • Access and prescribing.
  • Special topics.
  • Opportunities and challenges for emerging therapies.

Table of contents

  • Migraine - Access & Reimbursement - Detailed, Expanded Analysis (US)
    • Access & Reimbursement - Migraine Prophylaxis U.S. [October 2018]

Author(s): Audreza Das, P.G. Dip. ; Jonathan Searles

Audreza Das is a Senior Analyst in the CNS/Ophthalmology team at Decision Resources Group

She has authored content across indications, including neuropathic pain, age-related macular degeneration, treatment-related depression, painful diabetic neuropathy, and migraine. Ms. Das has previously worked at Novo Nordisk, as a Market Analyst for European markets. Previous experience at a SME, included developing disease competitive landscapes, covering global conferences etc. Ms. Das received her B.E. degree in Biotechnology from Birla Institute of Technology, a deemed university and her P.G. Diploma in Cancer Immunology & Biotechnology from University of Nottingham.

Jonathan W. Searles is a Senior Director in the CNS/Ophthalmology unit at DRG, overseeing the neurology research stream. Prior to joining DRG, Mr. Searles received a B.A. degree, summa cum laude, from Brandeis University; during this time, Mr. Searles conducted research projects at the Harvard University Peabody Museum and at Brandeis.

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