On March 10, 2023, the U.S. Food and Drug Administration (FDA) approved Zavzpret (zavegepant) nasal spray, the first intranasal formulation of a calcitonin gene-related peptide (CGRP) receptor antagonist. Zavzpret – indicated for the acute treatment of migraine with or without aura in adults – is now available as a 10 mg nasal spray device. While approved for acute treatment, Zavzpret is not currently indicated for the preventive migraine treatment .

Impact on workers’ compensation and auto no-fault industry

According to treatment guidelines, CGRP receptor antagonists are not considered first-line therapy for acute or preventive treatment of migraine. Other classes of medications such as nonsteroidal anti-inflammatory drugs (e.g., ibuprofen, naproxen) and triptans (e.g., sumatriptan, rizatriptan) have established efficacy in the acute treatment of migraine. Therefore, other medications should be tried initially, if clinically appropriate, prior to a CGRP receptor antagonist.

Upon review by our Optum Pharmacy and Therapeutics (P&T) Committee, Zavzpret nasal spray has been classified as non-formulary (i.e., requiring prior authorization or excluded) on our standard formularies, similar to oral CGRP receptor antagonists, such as Nurtec^® ODT (rimegepant) and Ubrelvy^® (ubrogepant). Because the safety of treating more than eight migraines in a 30-day period has not been established, quantity limits will apply.

Impact on Optum Settlement Solutions

The price of Zavzpret nasal spray for Workers’ Compensation Medicare Set-Asides (WCMSAs) is $220.00 per unit (one single-use spray bottle). Because other classes of medications are more cost-effective in the acute treatment of migraine, Optum recommends carriers, TPAs and claim handlers review claims where Zavzpret nasal spray has been prescribed to determine if more cost-effective alternatives are clinically appropriate. A CGRP medication may be considered for someone who cannot take triptans or has failed two triptans. In addition, a nasal spray may be considered if someone is unable to take an oral medication due to nausea or vomiting. The Optum Settlement Solutions clinical team can assist with this evaluation.

For more information on Zavzpret nasal spray, visit www.zavzpret.com.

If you have any questions, please contact your account manager, clinical liaison, or our Clinical Services team at 1-877-275-7674 ext. 8612.

Sources:

1. Pfizer Press release – Pfizer’s ZAVZPRET^™ (zavegepant) Migraine Nasal Spray Receives FDA Approval. March 10, 2023. Available at: https://www.pfizer.com/news/press-release/press-release-detail/pfizers-zavzprettm-zavegepant-migraine-nasal-spray.
2. Zavzpret (zavegepant) nasal spray [package insert]. New York, NY: Pfizer Labs; March 2023.
3. Ailani J, Burch RC, Robbins MS. The American Headache Society Consensus Statement: Update on integrating new migraine treatments into clinical practice. Headache. 2021;61(7):1021-1039. doi:10.1111/head.14153.
4. ODG by MCG Treatment Guidelines [database online]. An MCG Health Company. Last updated April 1, 2022.
5. Merative™ Micromedex® DRUGDEX® (electronic version). Merative, Ann Arbor, Michigan, USA. Available at: https://www.merative.com/clinical-decision-support (subscription required).
6. WCMSA Portal – Available at: https://www.cob.cms.hhs.gov/WCMSA/login.