Migraine Drugs Emerging as a Workers’ Compensation Cost Driver in California

Migraine medications made up less than 1% of all prescriptions for injured California workers in 2023 but accounted for 4.7% of drug payments, a steep increase from 0.6% in 2018, according to a California Workers’ Compensation Institute (CWCI) study. This growth is tied to the introduction of expensive, brand-name migraine treatments not listed in the state’s Medical Treatment Utilization Schedule (MTUS) Formulary. Migraines, often marked by severe headaches, nausea, and light sensitivity, are more common among women and typically diagnosed through patient symptoms rather than tests. In some cases, workplace factors like stress or injuries can trigger migraines, but lifestyle changes can also mitigate symptoms. Despite migraines not being a frequent work-related injury, the use of migraine drugs in workers’ compensation has surged, driven by newer, high-cost treatments.

The study analyzed over 9.5 million prescriptions from 2010 to 2023, finding that traditional medications like sumatriptan and rizatriptan saw a sharp decline in use, while new cost-driver drugs took their place. The study highlighted key migraine medications:

• Aimovig: Approved in 2018, this injectable migraine prevention drug accounted for 5.7% of 2023 prescriptions, with an average cost of $708.
• Ajovy: Another injectable treatment, Ajovy’s average cost per prescription reached $817 in 2023, representing 6.7% of spending.
• Emgality: Used for migraine prevention and cluster headaches, Emgality’s share of prescriptions fell, but it still consumed 2.8% of migraine drug spending.
• Ubrelvy: An oral medication for acute migraine relief, it accounted for 17.4% of drug payments in 2023, with an average payment of $1,507.
• Nurtec ODT: The only drug approved for both treatment and prevention, Nurtec’s use grew significantly, making up 15% of prescriptions and 41.6% of spending.
• Qulipta: Approved in 2021, this treatment quickly gained ground, representing 5.7% of migraine drug spending in 2023.

Overall, migraine medications have become the sixth-highest drug group in California workers’ compensation, nearing opioid spending and exceeding antidepressants and musculoskeletal drugs. Given the high costs and potential triggers not directly linked to work, stakeholders must carefully assess the work-relatedness and necessity of these treatments.

For more information or help, contact the Insurance professionals of EPIC’s CRA ProRental™ Insurance Program. Call us at: 800.234.6363 or email us at prorental@epicbrokers.com.