Migraine drugs costly addition to comp system: Report

The California Workers’ Compensation Institute reported that a nearly eightfold increase in migraine drug prescriptions coincided with the emergence of several high-cost drugs that are not included in the state’s formulary.

The CWCI study notes that migraine drugs represented only 0.7% of California workers compensation prescriptions filled in 2023, up from 0.2% in 2018. However, “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.”

CWCI said the top two migraine drugs prescribed in 2023 were sumatriptan and rizatriptan benzoate. Their share of work comp payments for migraine drugs fell to 5.5% in 2023 from 38% in 2018.

Over that same period, CWCI said, six cost-driver migraine drugs were approved by the U.S. Food and Drug Administration. These drugs are not listed in the state Medical Treatment Utilization Schedule formulary, making them subject to prospective utilization review.

“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,” CWCI said.

“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.”

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