Migraine Australia welcomes Ajovy on the PBS, looks to bring more migraine drugs to market
Migraine Australia has welcomed the news that the new migraine medication Ajovy will be listed on the PBS today for people with treatment resistant chronic migraine.
Ajovy (fremanezumab), made by Teva, is the second of the new CGRP antagonist medications for the management of migraine available on the Pharmaceutical Benefits Scheme (PBS). Lilly’s Emgality (galcanezumab) was announced in the budget and listed on the PBS in June. Both have tight eligibility restrictions, including requiring patients to have chronic migraine (15 headache days, 8 of which are migraine days, or more a month), have failed at least three older medications, and be under the care of a neurologist or pain specialist.
Migraine Australia founder Raphaella Kathryn Crosby says the announcement is fantastic news, but there is more work to do.
“There is a very long list of medications in the pipeline, and we need to get all of them on to the PBS.
“So far, each listing has been a monumental battle and taken well over a year since these medications were recommended by the independent Pharmaceutical Benefits Advisory Committee (PBAC).
“It shouldn’t be this hard, sick people shouldn’t have to fight this hard, and in our case, we’re going to be fighting this hard for many years to come unless the system is reformed,” Dr Crosby said.
Next to come in the list of new migraine medications is Vypeti (Eptinezumab), another CGRP monoclonal antibody preventative medication made by Lundbeck. This medication is particularly exciting as it is an infusion that could be used in hospital emergency rooms for people in migraine crisis. This will be followed by the first two CGRP targeting medications that treat migraine attacks acutely, super-drugs Nurtec (rimegepant), made by Biohaven with an Australian distribution deal currently being negotiated, and Ubrelvy (ubrogepant) made by AbbVie.
Migraine Australia is acutely aware that each PBS listing of a new migraine medication means millions to the budget because of the enormous number of people who live with migraine. The first CGRP antagonist and Time invention of the Year in 2017, Aimovig (erenumab), was rejected by the PBAC twice despite being a cost-effective medication, due to the high cost to the budget caused by an uncertain number of patients. The Ajovy and Emgality listings were only able to proceed thanks to those companies agreeing to a cap which limits the Government’s exposure to only pay for treatment for a fraction of the estimated 400,000 eligible chronic migraine patients. There are 4.9 million Australians who live with migraine.
With this in mind, Migraine Australia is actively looking to work with the Government, TGA, PBAC and the pharmaceutical industry to make older, cheaper, but still effective migraine medications more accessible.
“Most of the older drugs on our wish list simply never came to Australia, some are available but aren’t on the PBS, and others have been withdrawn but we’d still like them if we can get them,” Dr Crosby said.
The first priority is expanding access to triptans, a serotonin antagonist class of medications taken acutely to ‘abort’ migraine attacks. Some triptans were downscheduled to be available in small pack sizes over the counter earlier this year, but there is much more to do to encourage their uptake and safe use. Migraine Australia wrote to Health Minister Greg Hunt this week to ask for assistance with the following:
- Getting larger pack sizes of triptans both available in the country and available on the PBS. Currently triptans are limited to packs of two or four tablets; an average migraine patient can easily use 4 or more packs in a month.
- PBS listing of injectable sumatriptan. Injectable sumatriptan is particularly effective for those with rapid onset severe migraine as well as cluster headache but was never submitted to PBAC.
- Expedited TGA approval and PBS listing of three triptan products that never came to Australia because of the prohibitive nature of the PBS system, if willing suppliers can be found:
- Almotriptan, a triptan product with less side effects than the earlier generation triptans.
- Frovatriptan, a long-acting triptan proven particularly effective in the management of menstrual migraine.
- A sumatriptan-naproxen combination product which is available in other countries and is more effective than sumatriptan alone.
In addition, Migraine Australia has begun having conversations around two treatments for vestibular (dizzy) migraine that are available through a special access program but are not widely available or covered by the PBS, flunarizine and cinnarizine. These are being prioritized because anecdotally vestibular migraine patients are not responding well to the CGRP medications.
“In expanding the migraine toolbox, we think it is really important to improve access to older medications and encourage their use.
“We really hope we can bring some of these older, cheaper options to the market to give GPs more options in helping their migraine patients while they wait for a neurologist appointment, as well as making it more feasible for the government to make new medications available for those who have tried everything,” Dr Crosby said.
Raphaella Kathryn Crosby [email protected]
Currently, the only numbers on migraine prevalence in Australia is from the 2018 Deloitte Access Economics White Paper on Migraine in Australia: https://www2.deloitte.com/au/en/pages/economics/articles/migraine-australia-whitepaper.html
Please report on migraine using the right terminology!
Consult our language guide at www.migraine.org.au/language
Basics of Migraine www.migraine.org.au/about_migraine
CGRP therapies are a new type of medications used to prevent and treat migraine attacks. The medication blocks a protein called calcitonin gene-related peptide (CGRP) which has been found to surge in people’s blood during migraine attacks. CGRP may cause inflammation and pain in the nervous system of people who have migraine attacks. More about the CGRP medications including the access programs and PBS restrictions is available at https://www.migraine.org.au/cgrp
The full list of medications on the Migraine Australia wish list is available at: https://www.migraine.org.au/tool_box