Migraine Foundation Aotearoa New Zealand has submitted feedback to Pharmac and PTAC following its consideration of erenumab (Aimovig) for prophylactic treatment of migraine.
Pharmac is the agency in Aotearoa New Zealand that is responsible for deciding what medicines to fund. Pharmac operates from a fixed budget, which is set by the Government. To help in its decision-making, Pharmac has various clinical advisory groups, chief of which is the Pharmacology and Therapeutics Advisory Committee (PTAC).
In August 2021, PTAC met to discuss funding of new medications, including erenumab (Aimovig). Erenumab belongs to a new class of medications, called calcitonin gene-related peptide (CGRP) receptor monoclonal antibodies. It’s an injectable preventive migraine medication, developed specifically to act on pain pathways in the brain to stop migraine attacks from occurring.
At the meeting, PTAC recommended Pharmac fund erenumab with a low priority and only for patients with chronic migraine (at least 15 headache days per month). The designation of low priority means that erenumab is unlikely to be funded for some time, unless the Government increases the amount of money it gives to Pharmac.
Medicines on Pharmac's waiting list take around four and a half years (on average) to be funded. Many have been on the waiting list for years. Some may never be funded. There are currently 128 applications on Pharmac’s Options for Investment list, which is Pharmac’s ‘wish list’ of medications it would like to fund if it had the money. Many more are listed on Pharmac’s ‘only if cost-neutral or cost saving’ list. Erenumab is now under assessment by Pharmac, under its Factors for Consideration Framework, and is yet to be listed on a Pharmac funding list, despite PTAC’s recommendation.
Migraine Foundation Aotearoa New Zealand reviewed the minutes from the PTAC meeting, released late 2021. We have concerns about some of the inaccurate statements PTAC made regarding the prevalence of migraine in New Zealand, the social and economic burden and other information related to migraine and migraine care.
Migraine Foundation Aotearoa New Zealand has submitted feedback to Pharmac and PTAC, with recommendations including that the PTAC Committee:
- include a fuller consideration of the disability burden and economic costs of migraine in its funding priority decisions
- provide a clear and evidence-based justification for excluding people with moderate-high frequency episodic migraine from funded erenumab, or else expand the criteria to include people with moderate-high frequency episodic migraine
- seek further advice from the Neurology Subcommittee on the proposed Special Authority criteria, the impact on secondary services and the burden of syringe disposal. We support the proposal that referral to a neurologist is not required to access erenumab, due to equity concerns
- consult with relevant patient groups, to improve their understanding of the patient impacts of new medicines.
We indicated our desire for ongoing consultation and engagement with Pharmac on any issues related to migraine disease. We'll keep you posted on the response.