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Express Scripts announces new value-based program for migraines

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ST. LOUIS — Migraine headaches are a painful reality for 39 million Americans. Recognizing a need to help patients and plans improve migraine management, Express Scripts announced its new SafeGuardRx Migraine Care Value program will begin April 1, 2019.  This industry-first program combines a comprehensive clinical care program to help patients achieve better outcomes and experience fewer migraines, while helping plan sponsors more affordably cover new, preventive therapy for their members.

“Right now, most patients take medication to make migraines go away. Our goal is to help frequent migraine sufferers prevent the migraine from coming on at all,” said Harold Carter, senior director, product, Express Scripts. “Through the clinical care provided through our new Migraine Care Value program, Express Scripts specialist pharmacists in our Neuroscience Therapeutic Resource Center will identify patients using high amounts of acute migraine treatments, and work with them and their physician to move them to an appropriate preventive treatment.”

Once on preventive therapy, these neuroscience specialist pharmacists will offer coaching for members to achieve optimal medication adherence, and to help members avoid migraine triggers.  For members using newer calcitonin gene-related peptide (CGRP) inhibitors, our pharmacists will coach them on how to use these injectable medications and overcome barriers to achieving optimal results.

 Clinical evidence for recently approved CGRP inhibitors has shown these therapies are effective in reducing the frequency of migraine headaches in patients who experience four or more migraines per month. While drug makers have priced CRGP inhibitors in line with independent value-based assessments from organizations such as the Institute for Clinical and Economic Review (ICER), they are significantly more costly than previously available preventive migraine therapies and thus require conscientious management to ensure optimal patient outcomes.

Not all migraine suffers require CGRP-inhibitor therapy, but for those patients who meet the clinical guidelines for CGRP therapy, the Migraine Care Value program will prefer Aimovig (erenumab-aooe) and Emgality (galcanezumab-gnlm). As with any new-to-market medication, some patients will feel CGRP-inhibitors do not work for them. To help minimize plan sponsor exposure to the high cost of these therapies, Express Scripts is offering an early discontinuation reimbursement back to the plan sponsor when a patient discontinues therapy in the first 90 days.

“CGRP inhibitors can be life-changing for people with frequent migraines which is why it’s critical that these drugs be made affordable to both patients and plan sponsors,” said Carter. “With our SafeGuardRx solutions, we have pioneered an evidence-based approach that will now help migraine sufferers receive the best medication and specialized care to enable them to lead full and productive lives while reducing costs and wasteful spending for our clients.”


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