Oakland, CA – Migraine Drugs represented less than 1% of all prescriptions dispensed to California injured workers in 2023 but they consumed 4.7% of workers’ compensation drug payments, a nearly...
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Oakland, CA – Migraine Drugs represented less than 1% of all prescriptions dispensed to California injured workers in 2023 but they consumed 4.7% of workers’ compensation drug payments, a nearly 8-fold increase since 2018, which a California Workers’ Compensation Institute (CWCI) study links to the emergence of several high-cost brand drugs that are not listed in the Medical Treatment Utilization Schedule (MTUS) Formulary.
Migraine, a genetic, neurological disorder characterized by severe throbbing headaches often accompanied by nausea, dizziness, and sensitivity to light and sound, is not a common work injury, though it is common in the general population, especially among women, as more than 1 out of 6 women suffer from migraine attacks, 3 times the proportion noted for men. There is no diagnostic test for migraine, so diagnoses are based on a patient’s symptoms, personal and family history, and exposure to triggers that can include accidents or falls resulting in concussions or traumatic brain injuries, or events where work causation is more tenuous, including stress, exposure to light or odors, dehydration, diet, poor sleep, hormonal fluctuations, or overuse of medications. Changes to a person’s lifestyle and routines can reduce or eliminate their exposure to certain triggers, but in recent years the use of Migraine Drugs has increased as new pain relieving and preventive drugs have been approved and hit the market. Although the CWCI study notes that Migraine Drugs represented only 0.7% of California workers’ compensation prescriptions filled in 2023, that was up from 0.2% in 2018. This, along with the ongoing evolution of the Migraine Drug market and the growing use of several high-cost brand-name drugs for which there are no generic equivalents, drove the Migraine Drugs’ share of the workers’ compensation drug spend up from 0.6% in 2018 to 4.7% last year.
The study, based on data from CWCI’s Industry Research Information System (IRIS) database which contains details on more than 9.5 million California workers’ compensation prescriptions filled between 2010 and 2023, found that the top 2 Migraine drugs prescribed in 2023 were relatively inexpensive sumatriptan (i.e., Imitrex) and rizatriptan benzoate (Maxalt), which are used to relieve migraine symptoms. However, from 2018 through 2023 these 2 drugs’ share of the workers’ compensation Migraine Drug prescriptions dropped from 75.6% to 52.3%, while their share of the Migraine Drug spend fell from 38.0% to 5.5%. Over that same period, the study identified 6 cost-driver Migraine Drugs that were approved by the FDA and introduced into the system, but that are categorized as Not Listed drugs in the MTUS Formulary:
With the addition of these new medications, Migraine Drugs, which a decade ago did not rank among the top 10 drug groups in California workers’ compensation, now rank sixth in terms of total payments, with aggregate expenditures approaching those of Opioids and surpassing those of Antidepressants and Musculoskeletal Drugs. Their rapid growth in workers’ compensation raises concerns given the risks associated with these drugs, the long list of triggers that may or may not be work-related, the costs associated with long-term treatment of migraine, and the large percentage of American adults who suffer from the condition. Such concerns make it incumbent upon physicians, claims administrators, PBMs, and utilization reviewers to confirm a migraine diagnosis (vs. a tension headache of other condition), the work-relatedness of the condition, and that use of a specific Migraine Drug is appropriate and supported by the MTUS or other evidence-based guidelines.
CWCI has published more details and analyses on these drugs in a Spotlight Report, Trends in the Utilization and Reimbursement of Migraine Drugs in California Workers’ Compensation. Institute members and subscribers can log on to www.cwci.org to access the report under the Research tab, others can purchase it from CWCI’s online Store.