Beyond the headache: Disparities in access to branded migraine therapies

Migraine is a debilitating neurological condition affecting millions worldwide, with substantial impact on quality of life, productivity, and healthcare systems. In recent years, a new class of medications—most notably the calcitonin gene-related peptide (CGRP) inhibitors—has expanded the treatment landscape for both acute and preventive management of migraine. Despite their clinical promise, these newer branded therapies can be difficult for some patients to access, particularly when payer-imposed barriers such as prior authorisation, step therapy, or outright rejection are in place. For patients, these access issues can translate into poorer health outcomes. 

A patient advocacy client engaged Symphony Health, an ICON plc company, to better understand the real-world access challenges associated with branded migraine medications. The client sought to uncover whether disparities exist across sociodemographic lines in terms of payer rejection and patient abandonment rates, as well as to examine how these barriers may influence downstream health outcomes such as emergency room (ER) visits and hospitalisations.

Despite a clinical need and the availability of effective treatments, payer controls can limit patient access, particularly in populations with fewer resources or structural disadvantages. The client posed several critical questions to guide Symphony Health’s analysis: 

• Are there disparities in payer rejection rates across different sociodemographic groups, such as race, ethnicity, income level, or education?
• Do patient abandonment rates vary across these same segments?
• How do ER usage and hospitalisation rates differ among migraine patients who have faced utilisation management restrictions? 

These questions are not merely academic—they reflect growing concerns among pharmaceutical manufacturers, regulators, and patient advocacy groups about equity in healthcare access and outcomes. By answering them, the client hoped to inform strategies that could lead to more equitable access to migraine care.

Symphony Health’s Integrated Dataverse (IDV®) was leveraged to conduct a robust, retrospective claimsbased analysis. The approach involved evaluating a cohort of patients prescribed branded acute and preventive migraine therapies over a defined time period. Key variables analysed included: 

• Approval, rejection, and reversal rates for branded migraine medications
• ER and hospital admission rates among patients facing and not facing utilisation management barriers
• Stratification of patients by race, ethnicity, income, insurance type, and geography
• Use of proxy indicators to assess education and socioeconomic status when direct data was not available
• Patient abandonment rates—instances in which a prescription was written but not filled 

Importantly, utilisation management strategies such as step therapy (requiring patients to try and fail other medications first) and outright payer blocks were identified and included in the stratification.

The analysis revealed clear disparities in access to branded migraine medications across several dimensions: 

• Rejection Rates: Some minority ethnic groups experienced higher rejection rates for branded therapies compared to White/Caucasian patients.
• Abandonment: Patients from lower-income communities were more likely to abandon prescriptions, potentially due to out-of-pocket cost concerns, payer delays, or lack of care coordination.
• ER and Hospitalisation Rates: Patients who encountered utilisation management barriers—especially those subject to step therapy or payer blocking—were more likely to present in the ER or require hospitalisation for migraine-related complications. 

These findings suggest that structural access issues are not only limiting use of newer therapies but are also contributing to worse health outcomes in vulnerable populations.

Access barriers to branded migraine treatments are disproportionately affecting marginalised groups—ultimately leading to avoidable healthcare encounters and highlighting the urgent need for more equitable access to care.