New preventive treatments of episodic migraine – Qulipta™ (atogepant) and Nurtec® ODT (rimegepant) have lower cost alternatives for MSAs
New medication approval ― Qulipta™ (atogepant)
The U.S. Food and Drug Administration (FDA) approved a new medication to prevent episodic migraine (fewer than fifteen headache days per month) on September 28, 2021. This approval allows AbbVie, Inc. to market Qulipta - a once daily oral calcitonin gene-related peptide (CGRP) receptor antagonist - for migraine prevention. Qulipta is not indicated for the acute treatment of migraines like other oral CGRP receptor antagonists on the market, such as Ubrelvy™ (ubrogepant) and Nurtec® ODT (rimegepant). Qulipta is the second oral CGRP receptor antagonist to be approved for prevention of episodic migraine.
Expanded indication ― Nurtec ODT (rimegepant)
Nurtec ODT was the first oral CGRP receptor antagonist to be FDA-approved for preventive treatment of episodic migraine on May 27, 2021. Previously, Nurtec ODT was only indicated to treat acute (immediate) migraine with or without aura (often described as a visual disturbance such as flashing lights) in adults. Nurtec ODT is now FDA-approved for acute and preventive treatment of migraine.
Impact on workers’ compensation and auto no-fault industry
According to treatment guidelines, oral CGRP receptor antagonists are not considered first-line therapy for acute or preventive treatment of migraine. Upon review by our Pharmacy and Therapeutics (P&T) Committee, both Qulipta and Nurtec ODT are non-formulary on our standard formularies, meaning they are either excluded (i.e., First Fill) or require prior authorization.
In addition, for Nurtec ODT, because the safety of taking more than 18 tablets in a 30-day period has not been established, if authorized, the quantity for this medication is limited to 18 tablets per 30 days.
|Qulipta (atogepant) tablet||Nurtec ODT (rimegepant) tablet|
|Indication(s)||Migraine prevention||Migraine prevention and treatment|
|Available strengths||10 mg, 30 mg and 60 mg||75 mg|
|Orally disintegrating tablet||No||Yes|
|Dosing guidelines (prevention)||One tablet once daily||One tablet every other day|
|Dosing guidelines (acute treatment)||Not applicable||One tablet at onset of headache as needed|
|Dosing limitations||Maximum dose: 60 mg per day||Up to 18 doses in a 30-day period; Maximum dose: 75 mg in a 24-hour period|
Impact on Optum Settlement Solutions
Pricing for these migraine medications for Workers’ Compensation Medicare Set-Asides (WCMSAs) is as follows:
Qulipta (all strengths): $39.64 per tablet
Nurtec ODT: $133.87 per tablet
Other classes of medications are more cost-effective in the prevention of migraines and in the treatment of acute migraines. It is our recommendation that carriers, TPAs and claim handlers review claims on which Qulipta or Nurtec ODT have been prescribed to determine if a more cost-effective alternative is clinically appropriate. The Optum Settlement Solutions clinical team can assist with evaluation of claims and identification of clinically-appropriate, more cost-effective therapy.
If you have any questions, please contact your account manager, clinical liaison or our Clinical Services team at 1-877-275-7674 ext. 8612.
- FDA approves Biohaven’s Nurtec® ODT (rimegepant) for prevention: Now the first and only migraine medication for both acute and preventive treatment. [press release]. New Haven, CT: Biohaven Pharmaceutical; May 27, 2021.
- Nurtec ODT [package insert]. New Haven, CT: Biohaven Pharmaceutical; 2021. Available at: https://biohaven-nurtec-consumer-assets.s3.amazonaws.com/nurtec-prescribing-information.pdf.
- Ailani, J, Burch, RC, Robbins, MS; the Board of Directors of the American Headache Society. Update on integrating new migraine treatments into clinical practice. Headache. 2021; 61: 1021– 1039. https://doi.org/10.1111/head.14153.
- ODG by MCG Treatment Guidelines [database online]. An MCG Health Company. June 2, 2021.
- Qulipta™ (atogepant) [package insert]. Dublin, Ireland: AbbVie; September 2021.
- FDA Approves QULIPTA™ (atogepant), the First and Only Oral CGRP Receptor Antagonist Specifically Developed for the Preventive Treatment of Migraine. [press release]. North Chicago, Ill: AbbVie Inc.; September 28, 2021.
- RED BOOK™ - https://www.ibm.com/products/micromedex-red-book (Subscription required).
- WCMSA Portal - https://www.cob.cms.hhs.gov/WCMSA/login.