OBJECTIVES:

Manufacturers offer PAPs (e.g. free trial program, bridge program, copay card, eVoucher, denial conversion) to reduce out of pocket costs for patients. This study describes utilization and switching patterns of PAPs among patients treated with anti-CGRP pathway monoclonal antibodies (mAbs) for migraine prevention.

METHODS:

In this retrospective cohort study using IQVIA open-source pharmacy and medical claims, patients ≥18 years with ≥1 claim for erenumab, fremanezumab, or galcanezumab between 05/17/2018-10/31/2020 were identified and indexed on the date of their first claim. Patients were required to have ≥2 medical claims ≥30 days apart within the 360-day pre-index period and use of a pharmacy that consistently contributed data over 180-days of follow-up. Anti-CGRP pathway mAb claims, including those from PAPs, were stratified by payer, and further categorized as visible (commercial, copay card, eVoucher) or non-visible (free trial program, bridge program, denial conversion, cash) based on whether the claim would be expected to produce a record in adjudicated insurance claims databases. Use and switching of PAPs and payers were evaluated during follow-up.

RESULTS:

Of the patients identified (n=233,472 erenumab, n=66,731 fremanezumab, n=123,715 galcanezumab), the majority used a PAP for their first claim: 128,411 (55%) erenumab, 45,406 (68%) fremanezumab, 71,614 (58%) galcanezumab.

Non-visible payers were billed for 107,817 (46%) erenumab, 23,293 (35%) fremanezumab, and 21,660 (18%) galcanezumab index claims. Among patients with a non-visible index payer, a switch to a visible payer occurred in 31,774 (29%) of erenumab, 4,518 (19%) of fremanezumab, and 9,817 (45%) of galcanezumab patients during follow-up. Median time to switch from non-visible to visible payer was 61, 70, and 41 days, respectively.

CONCLUSION:

Use of PAPs and non-visible payers in insurance claims was common yet variable across anti-CGRP pathway mAbs. Therefore, cautious interpretation is warranted when assessing incident exposure to anti-CGRP pathway mAbs in studies using adjudicated insurance claims data.