Many Patients Who Start Botulinum Toxin for Migraines Discontinue Treatment Early

A real-world study revealed that less than half of patients who begin treatment with onabotulinumtoxinA (Botox; Allergan, Madison, NJ) to prevent chronic migraine receive all recommended treatments of the therapy. The study, being presented at the Academy of Managed Care Pharmacy's (AMCP) Managed Care & Specialty Pharmacy Annual Meeting, analyzed pharmacy and medical claims data for 15 million commercially insured patients. Of the 61,944 onabotulinumtoxinA treatment (BT) claims identified from October 2017 to September 2018, BT for migraine accounted for 66% of claims and 65% of expenditures. 

Less than half (47%) of patients who started BT treatment for the first time received all 4 recommended treatments in the first year of therapy. Data for the real-world costs of BT and adherence to treatment suggest a need to compare use, cost, and adherence when making managed care decisions about chronic migraine treatment coverage.

Using data for real-world units billed and paid, the average allowed BT cost was $1,576 (including administration costs) for the labeled 84-day dosing schedule. Researchers determined that 34% of the cost was due to drug waste and administration. 

“Botulin toxin treatment is considered by the Institute for Clinical and Economic Review to be priced to value, but real-world data should be considered,” said Patrick Gleason, PharmD, assistant vice president of health outcomes, Prime Therapeutics. “Our claims data reveal that BT for migraine was associated with substantial drug waste, increased total migraine cost of care, and low BT persistency. Better pricing of migraine therapy relative to its value is needed, so we can help ensure members use the most cost-effective chronic migraine treatment.”