Some Insurance Companies may be Placing Unfair Restrictions on Access to New Migraine Prevention Treatments

A New Blog from the National Headache Foundation’s Dr. Timothy Smith

I recently read a communique indicating that some insurance payers are adopting prior authorization rules for the newly marketed migraine prevention medication, Aimovig (erenumab) that would potentially deny or significantly limit coverage for prescriptions written by clinicians who do not hold subspecialty certification in Headache from the United Council of Neurologic Specialties (UCNS). Since less than 500 providers in the entire world have this certification, this is an unreasonable requirement which will unnecessarily block access to many of those most impacted by migraine. When one considers that there are almost 40 million patients with migraine in the US, this is an especially unconscionable restriction. Furthermore, the geographic distribution of UCNS certified headache specialists is uneven with a concentration of providers in the East and West coast areas, leaving many states with only one or two providers, and some with none! How are patients supposed to be able to access a medication with this restriction on coverage? And to our knowledge, holding a UCNS certificate has never been suggested as evidence of competence for prescribing Aimovig. In fact, some of the very clinicians who have been involved in research and development of the CGRP antibodies, including Aimovig, are not UCNS certificate holders. It would be illogical for these and other competent prescribers to be restricted from prescribing to patients because of this requirement.

Identifying which plans have established the UCNS certificate requirement is not easy to do. We contacted several payers and queried them on the policy. Most would not confirm or refute the allegation, mostly indicating that they administer numerous plans and each one has its own coverage rules and limitations. In other words, the only way to know the coverage rules is to try and fill a prescription and see if it “goes through.” However, we have heard several anecdotes from both providers and patients describing situations where a prescription was denied coverage due to this limitation. To be clear, not all insurance plans thus far are placing this restriction on access to therapy, but when one insurer takes this stance others will follow.

For now, it is hard to foresee how much difficulty patients will face across the board in obtaining access to Aimovig or other new CGRP antibodies set to come to market over the next 18 months. But the National Headache Foundation and its thousands of patient constituents will be keeping an eye on the developments and we promise to provide updates along the way. It is not our policy to pick or support individual medications. But we share with many patient advocacy groups our enthusiasm for the availability of CGRP antagonists to highly impacted migraine patients who cannot obtain relief from one or more previously available migraine preventive medications. Those patients should not be denied access based on subspecialty credentials of their provider. This goes the same for any novel new therapy with good scientific evidence to support its use from both safety and effectiveness standpoints.

If you are aware of patients with migraine or other disabling disorders experiencing unfair impediments to care/medication access, be sure to let us know those stories. Visit www.headaches.org for helpful information and/or follow us on Facebook or twitter to keep up to date on the latest. You can also visit www.headachestory.com to share your own journey or support others who have provided their stories. You may be surprised to learn how many others may have common experiences with you. Finally, and most of all, remember YOU ARE NOT ALONE! The NHF is here for you!

Timothy R Smith, MD, RPh
First Vice President and Board of Directors Member
National Headache Foundation