Benefit standards are the key to the migraine market

Entering the benefit range for CGRP treatments

Patient history/treatment effectiveness demonstration task

Treatment options are also changing at clinical sites as CGRP (calcitonin gene-related peptide)-based migraine treatments are entering or about to enter the benefit range.

 

However, given that the standard is high, it is expected that patients who receive actual benefits will be limited, so it is evaluated that the task to expand accessibility remains.

 

CGRP-based drugs are attracting attention in migraine treatment because they target CGRP pain-causing substances in the migraine market, which has not had a suitable treatment.

 

This is why existing drugs are relatively free from side effects in that they have a mechanism to target only CGRP if they generally suppress pain-causing substances.

 

This is already being paid attention not only abroad but also in Korea.

 

The Korean Headache Society also recommended the use of CGRP treatment as a preventive drug for adult chronic migraine patients in the revised medical guidelines.

 

(Criteria level: I, Recommended level: Strong for).

 

Currently, CGRP target antibody treatments in Korea have entered the market with Lilly's Emgality first, and Handok Teva released Ajovy last year.

 

With high prices still acting as a hurdle, the number of prescription options has also increased as Emgality entered the benefit range on the 1st.

 

In addition, Ajovy, a competitive drug, is also expected to enter the benefit range soon as it is set to negotiate drug prices after passing the 9th Drug Benefit Evaluation Committee review.

 

Experts are also paying attention to the reduction in drug prices due to the entry of benefits.

 

According to the announcement by the Ministry of Health and Welfare, the burden of patient costs has been reduced from about 3.8 million won to 1.15 million won due to the application of Emgality's benefit.

 

Cho Soo-jin, chairman of The Korean Headach Society, said, "The migraine itself has been used at a cost burden in that it hinders the quality of life and reduces work efficiency," adding, "The fact that migraine treatment has been paid is important in that it is the beginning to expand into areas where migraine is recognized as essential." It is good news that many patients hesitated to receive treatment due to high costs.

 

Lee Won-gu, a professor of neurology at Kosin University Hospital, said, "It has been difficult for medical staff to recommend treatment to patients due to price barriers." He said, "As we have entered the salary, accessibility will improve from the perspective of medical staff and patients." However, some say that there may be fewer patients than expected as Emgality's benefit standards are difficult.

 

According to the Ministry of Health and Welfare, Emgality's detailed criteria for health insurance benefits are preventive measures for chronic migraine patients aged 18 or older that meet the International Headache Classification (ICHD-3) diagnostic criteria.

 

A response evaluation (headache period, MIDAS, etc.) should be conducted every three months before administration begins (within the last month) and after administration, and the administration period is applied for up to 12 months, patients who have a history of migraine for at least one year, have a monthly headache for at least six months before administration for at least 15 days, and have migraine headaches for at least eight days a month, and patients who have failed to treat three or more types of migraine prevention drugs within the last year (with the maximum dose of each drug, the number of migraine days per month does not decrease by 50% or cannot be used as side effects or taboos even after at least 8 weeks), if looking at the details.

 

Professor Lee said, "There was a discussion among experts that there was a risk of cutting if the standards were not used well for patients who needed to be used," and explained, "As we need to prove the records, history of treatment, and headache period, we think the prescription may be limited at primary clinics or general hospitals." If the use of the treatment is recognized for up to one year or if the treatment effect is not proven every three months, the elimination is also expected to be a task in the future.

 

Cho said, "If CGRP-based treatments are recognized as a single drug, they are recognized for up to one year, but in some cases, 18 months or more may help patients." He said, "Even if Ajovy enters the benefit, it is currently stipulated that the drug cannot be changed, so it remains to be seen how to evaluate this part in the future."