If you know anything about innovations in migraine treatment, you would have heard of the new migraine-specific medications for prevention of migraine – calcitonin gene-related peptide (CGRP) monoclonal antibodies. They’ve been the first real hope for people with treatment-resistant migraine in many years. They don’t work for everyone, but for some people, they've been life-transforming, providing a significant reduction in frequency and severity of migraine attacks.
In Aotearoa, there are two CGRP monoclonal antibodies currently available – erenumab (trade name Aimovig) and galcanezumab (trade name Emgality). Neither are funded but Migraine Foundation Aotearoa New Zealand (MFANZ) submitted an application to Pharmac for funding of Emgality in November 2022; and an application was received by Pharmac for Aimovig in Feb 2021.
Once Pharmac receives an application, the first step is for it to be reviewed by the Pharmacology and Therapeutics Advisory Committee (PTAC), their general clinical advisory group. Here’s the timeline for the Aimovig application so far:
PTAC assesses Aimovig application August 2021. At this time, PTAC recommends the application be reviewed by the Neurological Advisory Committee, one of Pharmac’s specialist advisory committees.
MFANZ launches in April 2022. We were concerned about PTAC’s assessment of the Aimovig application and provided written feedback to Pharmac in April 2022 backed by a letter of support from the New Zealand Pain Society.
PTAC considers our feedback at their meeting in August 2022.
Pharmac publishes the record of the PTAC meeting in August 2022 online in November 2022, and we were informed of this in December 2022.
The August 2022 PTAC record recommends that the Aimovig application be reviewed by the Neurological Advisory Committee.
We have some major concerns with the August 2022 PTAC recommendation. The Neurological Advisory Committee has not met since October 2021 and has no meetings scheduled. This means there is an open-ended delay until the Aimovig application will be progressed to the next stage of assessment. It has already been nearly two years since Pharmac received the application.
In addition, the Neurological Advisory Committee includes a psychiatrist and a paediatric anaesthetist but doesn't include any members who have a stated interest in migraine. We do not consider this to be appropriate, especially given the bias against migraine treatment in Aotearoa. PTAC illustrated this bias in its own notes from the August 2021 meeting, when it stated that “access to neurology specialists, particularly for people with migraines in the public health system is currently limited due to high demand for neurology services”. That is, migraine is not prioritised for treatment by neurologists in Aotearoa. Hence, it would be inadequate and inappropriate for the Aimovig application to be reviewed by a group of specialists that does not include a migraine and headache specialist.
We have provided feedback (again) to Pharmac on their second round of recommendations on the Aimovig application. We have requested Pharmac expedite a meeting of the Neurological Advisory Committee to prevent further delays in the application process and include consultation with headache specialists in their assessment of both the Aimovig and Emgality applications. We also provided advice around some incorrect language in the PTAC record relating to migraine, and requested more information about how PTAC’s new reflections on the Aimovig application will impact our application for Emgality.
It feels like we’ve made one step forward and two steps back. We need to keep the pressure on, letting Pharmac know there is a strong group of people in the community who want these medications to be made accessible to all people, not just those who might be able to afford them.
If you can, take one of the actions in our advocacy toolkit. Everything helps - a social media post, a conversation with a friend or colleague, a letter to an MP, all raise awareness of this condition that has been ignored for too long. We’ll continue engaging with Pharmac. We know it is going to be a long haul.