Last updated on 19 August 2022.
In this update:
- Introduction to this new class of treatment
- PBS Listing & Availability Update
- Aimovig (erenumab)
- Emgality (galcanezumab)
- Ajovy (fremanezumab)
- Vyepti (eptinezumab-jjmr) [NEW]
- Timing Expectations
- Our Response to COVID-19
A new category of treatments has recently been developed to prevent migraine attacks from occurring. These are the Calcitonin Gene-Related Peptides (CGRP) monoclonal antibodies. We have spoken to our community about these new migraine treatments in the past. View this article for more information about the anti-CGRPs or watch a presentation from a headache specialist to learn more about CGRP and other new treatments for migraine.
In Australia, four different manufacturers have applied for Therapeutic Goods Administration (TGA) approval and several have also applied for Pharmaceutical Benefits Scheme (PBS) coverage within the past 2 years. The process can be complicated and time-consuming. Understandably there is some confusion over the availability and access to these treatments.
Below is an update of the current status of each of them:
- Aimovig (erenumab)
- Emgality (galcanezumab)
- Ajovy (fremanezumab)
- Vyepti (eptinezumab-jjmr) [NEW]
Aimovig
After several failed attempts Novartis withdrew their application for Aimovig coverage on the PBS. The cost for one month treatment and the full dosage of 140ml is $695. Aimovig is only available via a private prescription. Patients order online and have their order shipped to a local pharmacy for pickup. Novartis stated that they will provide an extra dose free with the first order.
Read our comprehensive article about Aimovig >
Emgality
In July 2019, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the inclusion of Emgality (galcanezumab) on the PBS for people with chronic migraine who have unsatisfactorily tried at least three prevention therapies. Emgality was the first medicine of its class to have received a positive recommendation from the PBAC.
With the announcement of the 2021-22 budget, the Federal Government announced that as at 1st June 2021, Emgality would be available on the PBS. Patients must fulfill the following criteria to be eligible for PBS coverage:
- the patient has chronic migraine
- three other treatments have failed the patient (for example through a lack of efficacy or intolerable side effects)
- the script is prescribed by a neurologist
Emgality has an existing program for patients which will continue for those who are not eligible for PBS coverage. The treatment for ineligible patients will cost $263 per month. For those who are able to receive PBS coverage, the monthly cost is $30. For concession card holders it’s $7.30.
Read our comprehensive article about Emgality >>
Ajovy
On 1st August 2021 Ajovy (fremanezumab) was listed on the PBS for chronic migraine patients 15 months after it had received a positive recommendation from the PBAC. A new prescription from a neurologist will be required to access PBS pricing.
PBS access was expanded to include people with treatment-resistant high frequency episodic migraine on 1st November 2023. High frequency episodic migraine (HFEM) includes people who have 8-14 headache days per month. Research shows that HFEM actually has more in common with chronic migraine than it does with low frequency episodic migraine (D Buse et al, 2020). Preventive medication is an important part of migraine management for people with HFEM, so this expanded access is an exciting first for CGRP monoclonal antibodies.
If you aren’t eligible under the PBS criteria, you can still access Ajovy through the Momentum program with a private prescription. The Momentum program allows you to access Ajovy at a reduced price. When you receive your private prescription, your doctor will provide you with the next steps to purchase Ajovy.
Additional information is available from your neurologist. Alternatively, if your neurologist is not aware or if you are not seeing a neurologist then you can contact Teva and request details be directly sent to your doctor. Teva can be reached on Phone: 1800 AU TEVA (1800 28 8382) Email: MedInfo.ANZ@tevapharm.com
Read our comprehensive article about Ajovy >>
Vyepti
Vyepti is another CGRP monoclonal antibody that uses a different method of administration. It is administered intravenously (IV) once every 3 months or four times per year.
Vyepti has been approved in Australia and is listed on the PBS, as of August 1st 2023. This was a faster timeline than the other two CGRP monoclonal antibodies that are listed on the PBS – Vyepti received a positive recommendation on August 19th 2022, meaning it took less than a year to be added to the PBS.
If you are not eligible to access Vyepti through the PBS, you can get a private prescription which has an estimated cost to the patient of between $1,700 and $1,800 per quarter.
Read our comprehensive article about Vyepti >>
Timing Expectations
With Emgality and Ajovy listed on the PBS it paves the way for others to follow. This has been a long time coming with submissions first called for this new generation preventive treatment over 2 years ago with 1,800 submissions from the migraine community. There have also been several calls for submissions since then. Earlier this year Migraine & Headache Australia’s Carl Cincinnato testified in front of a Parliamentary Enquiry Hearing regarding the approval process of new drugs to share our community’s perspective and the impact of such delays.
The next steps for other treatments which have received a positive recommendation from the PBAC is for price negotiations between the manufacturer and the Department of Health to be agreed. These negotiations can take months or even years. We are hopeful that other CGRPs can follow the roadmap established by Teva (Ajovy) and Eli Lilly (Emgality), leading to faster approvals. This will provide patients with a range of options to discover something that best addresses their migraine disease.
In the meantime we hope this information provides some reassurance that progress is being made. We will continue to represent the patient voice in the need for fair access to proven and safe treatments for migraine.
