(53) Real-World Patterns in Preventive CGRP Use Pre and Post AHS 2024 Position Statement Update in a Commercially Insured Population

Background: : In March 2024, the American Headache Society (AHS) recommended earlier initiation of preventive CGRP (pCGRP) therapies for migraine. Despite proven efficacy, uptake has been limited by access barriers, including prior authorization, cost, and provider familiarity. Evaluating changes in pCGRP use following this update provides insight into adoption trends and treatment gaps.

Objective: : To evaluate pCGRP utilization patterns before and after the 2024 AHS position statement and identify disparities by prescriber type, demographics, and geography in a large, commercially insured North Carolina population.

Methods: : This retrospective observational study analyzed pharmacy claims for Blue Cross NC members aged 18–64 with a pCGRP claim between March 2023 and February 2025. Members were classified into treatment scenarios based on preventive and acute therapy fills in pre- and post-position statement periods. Descriptive statistics summarized initiation, continuation, discontinuation, and switching, as well as prescriber specialty, age/gender, and geographic trends.

Results: : Among 5,520 migraine members, pCGRP utilization increased post-guideline. New starts accounted for 1,771 (32.1%) members, while 2,609 (47.3%) continued therapy. Discontinuations (430; 7.8%) most often transitioned to acute-only therapy (4.73%). Of note, 26.7% of members initiated pCGRP from no prior preventive or acute-only treatment. Neurologists (30.4%) and non-physician prescribers (20.1%) drove prescribing, while family/internal medicine accounted for < 8%. New starts were concentrated in females aged 40–60. Uptake was higher in urban regions, with substantially lower adoption in rural areas, suggesting geographic disparities.

Conclusions: : The 2024 AHS update was associated with increased pCGRP initiation and persistence, particularly among middle-aged female members. Prescribing patterns highlight the role of neurologists and advanced practice providers, while geographic analysis revealed access gaps in rural areas. Findings underscore the need for payer and provider strategies to address disparities and ensure equitable access to innovative migraine therapies.

Sponsorship:: Pfizer, Inc.
Blue Cross Blue Shield of North Carolina