Initiation of Fremanezumab Earlier in the Treatment Cycle may Result in Cost Savings to Payors in the United States
Stewart Tepper1, Mario Ortega2, Maurice T Driessen3, Olawemimo Odebiyi4, Timothy Klein5, Lee Smolen5
1Geisel School of Medicine At Dartmouth, 2Teva Pharmaceuticals, Parsippany, NJ, USA, 3Teva Pharmaceutical Industries Ltd, 4Teva Branded Pharmaceutical Products R&D, Inc, 5Medical Decision Modeling Inc
Objective:

To determine if removal of some or all prior authorization (PA) steps before initiation of fremanezumab treatment results in more cost-efficient care.

Background:

Currently, US payors require at least two to three prior PA steps before allowing patients access to calcitonin gene-related peptide (CGRP) monoclonal antibodies (mAbs). During each PA step, patients may find efficacy with an oral preventive, fail the treatment regimen altogether, or step-through to other older preventive therapies while incurring costs of acute migraine drugs throughout the entire course of treatment. Healthcare provider supported, patient‑centric holistic care models indicate that CGRP mAbs should be accessible at earlier stages of treatment.

Design/Methods:
An Excel-based economic model was developed to estimate the cost savings associated with removing PA steps for fremanezumab over 1 year (13 four-week cycles) using wholesaler acquisition costs. The model evaluated migraine patients eligible for fremanezumab treatment who eventually received fremanezumab after oral preventive migraine treatments failed, and migraine patients who stopped oral preventive migraine treatment after a PA failure and continued on acute gepant treatment for the remainder of the year. 
Results:

Overall cost associated with implementation of three PA steps prior to a patient receiving treatment with fremanezumab (plus acute treatment with gepants) was $12,790/patient/year. Reducing from three PA steps to two resulted in a cost increase of $93/patient/year (overall cost; $12,883/patient/year). However, moving from three PA steps to one was associated with a saving of $152/patient/year (overall cost; $12,638/patient/year). The greatest cost savings were reported when no PA steps were initiated, resulting in savings of $1,530/patient/year (overall cost; $11,260/patient/year).

Conclusions:

While migraine represents a considerable economic burden, it is increasingly important to initiate timely, migraine-specific, preventive treatment. This model demonstrated that removing payor PA criteria for fremanezumab may yield annual direct-cost savings.

10.1212/WNL.0000000000202975