Mounting access barriers to headache and migraine treatments have sparked concerns among patients and providers.
Step therapy, also known as “fail first,” is key among the hurdles currently facing patients. The process delays treatment by requiring patients to try and fail insurer-preferred medications before accessing the medication prescribed by their doctor.
United Healthcare’s Step Therapy Policy
One troubling example is United Healthcare’s four-step process for migraine patients to access an infused treatment known as a CGRP inhibitor. CGRP inhibitors help to prevent migraine attacks. Yet for the infused CGRP inhibitor, United Healthcare’s policy requires patients to try and fail four other medications first, including two other CGRP inhibitors.
The policy falls flat with health care providers.
Headache specialist Heather McCoy, DNP, called the approach “impractical and restrictive.” Neurologist Christopher Gottschalk, MD, emphasized the importance of access, noting that the drugs provide “excellent reduction in headache rates” and serve some patients “better than any drugs we’ve seen in the past.” Both providers are members of the Alliance for Patient Access’ Headache and Migraine Disease Working Group.
In addition to undermining patient care, the policy could also fail to provide the cost savings insurers desire.
As explained by Christina Treppendahl, FNP-BC, also of AfPA’s Headache and Migraine Disease Working Group, comprehensive coverage for the new infused CGRP could actually provide “cost savings to insurers by decreasing acute medication use and reducing emergency department and urgent care visits.” Approximately 1.2 million Americans visit the emergency department for migraine treatment every year.
Insurance Barriers in North Carolina & Alabama
United Healthcare is not the only insurer whose step therapy policy is undermining patient care. Restrictive health plans in in North Carolina and Alabama have also elicited concerns from health care providers.
In a recent letter to Blue Cross Blue Shield North Carolina insurers, the Alliance for Patient Access emphasized the importance of keeping treatment decisions between patients and their clinicians, noting that step therapy, “inappropriately places a significant barrier between patients and the therapies their clinicians have prescribed.”
Meanwhile, AfPA and clinicians in Alabama urged insurers to “take a patient-centered approach by providing access to the full range of CGRP inhibitors.” Their efforts were answered by Alabama insurers, who expanded coverage to include multiple CGRP inhibitors.
Broad access to migraine treatments could provide more opportunities for patient-centered care, unprecedented relief and overall cost savings. By reducing barriers like step therapy, health plans can improve quality of life for people with migraine disease – and allow for patients and clinicians to together determine the best course of migraine care.