OBJECTIVES: Finland and Sweden, with similar reimbursement systems, are known as price sensitive when it comes to the use of pharmaceuticals. In 2020, three calcitonin gene-related peptide (CGRP)-inhibitors for migraine, generally deemed comparable in effect, were available on these markets. They pose a suitable example to study and compare price sensitivity and patient uptake in these countries.

METHODS: Included CGRP-inhibitors, reimbursed in both countries in 2020, were: Aimovig, Ajovy and Emgality. Data for the period 2020-2023 was retrieved on list prices, confidential net price agreements, treatment recommendations and number of patients on each drug, which was analysed using descriptive statistics.

RESULTS: Aimovig entered both markets first, followed by Ajovy, both with confidential net price agreements. Emgality was third on each market; in Finland with a confidential net price but in Sweden only using the list price, set lower than the list prices of its competitors. Emgality was recommended as first choice in Sweden, leading to cessation of the confidential net price agreements and lowering of list prices. In Finland, the agreements remained but list prices dropped anyway.

Although Aimovig has been the cheapest option in Sweden since 2021, patient numbers have steadily declined over time. The data shows a clear increase in patient numbers for Emgality in 2021 and a constant increase for Ajovy over the studied years. By the end of 2023, Ajovy had 48% of the market share among the drugs in Sweden, Aimovig 41% and Emgality 11%. Finland followed the same pattern with 47%, 33% and 20% for Ajovy, Aimovig and Emgality respectively.

CONCLUSIONS: Studied price differences of CGRP-inhibitors were not large enough to influence physicians’ decisions whereas patient preferences (e.g., fewer administrations) seemed to drive the uptake. The findings revealed a preference among Swedish payers for list prices likely due to the high administrative burden of confidential net price agreements.