OBJECTIVES: To report the results of an outcomes-based agreement (OBA) executed in a large integrated delivery and finance system for patients with migraine who were prescribed erenumab (CGRPi).

METHODS: This is a prospective real-world analysis of commercial/health insurance exchange members who were new to CGRPis and filled a new prescription for erenumab (index date) during a 180-day period within the contract period (2/15/2020-12/31/2023). Outcomes included adherence, work absenteeism, and rescue medication utilization for patients who were adherent. Proportion adherent and rescue medication utilization were assessed for the entire cohort, whereas work absenteeism was only evaluated for a subset for whom work outcomes data were available. Adherence was defined as the proportion of total units of study medication claimed by those with at least four claims in six months. Work absenteeism was measured as the average relative increase/decrease in illness/unscheduled time off (180 days pre-and post-index date). Rescue medication use was measured as the relative change in average daily dose of medications such as triptans and opioids (180 days pre-and post-index date).

RESULTS: 4,581 patients filled an erenumab prescription during the contract period. 1,092 patients were classified as new to CGRPis. 865 constituted the qualified patient cohort, out of which 224 patients had work outcomes data. Percent adherence was 80.5% and 81.7% for the entire patient cohort and work outcomes cohort, respectively. Work absenteeism reduced by 5.6% (p=0.6644) for the work outcomes cohort. Rescue medication use decreased by 3.4% (p=0.589) for all qualified patients over the contract period. Limitations: Rescue medications included opioids which could be used for non-migraine pain, and study outcomes could have been impacted by the onset of the COVID-19 pandemic.

CONCLUSIONS: Our findings suggest that the use of erenumab was beneficial to patients, due to high adherence rate. Including a work outcomes cohort provided valuable insights as migraines impact work-related disability.