Triptans available OTC in 2021 but CGRP inhibitors remain in PBS limbo

Headache

By Michael Woodhead

19 May 2020

People with migraine will be able to buy sumatriptan and zolmitriptan over the counter without a prescription from February 2021, the TGA has confirmed.

But subsidised access to the new CGRP targeted migraine prevention therapies looks likely to remain elusive into 2021 as manufacturers continue negotiations with the department of health over pricing for PBS listings.

On 7 May the TGA’s Advisory Committee on Medicines Scheduling confirmed its February 2020 interim decision to down-schedule triptans to Schedule 3 (OTC) medicines to allow pharmacists to diagnose migraine and dispense the packs of two tablets for people in the early stages of an attack.

The rescheduling will also allow triptans to be advertised to the public.

Meanwhile, access to the anti-CGRP therapies such as galcanezumab (Emgality), fremanezumab (Ajovy) and erenumab (Aimovig) will remain via private prescription for the foreseeable future despite two of them being recommended for PBS listing by the Pharmaceutical Benefits Advisory Committee (PBAC).

An update on new treatments released by Migraine and Headache Australia notes that galcanezumab received a positive recommendation for PBS listing in July 2019 for people with chronic migraine who have unsatisfactorily tried at least three prevention therapies.

However the PBS listing has been delayed because the manufacturer Lilly and the government have yet to agree on a PBAC recommendation that would required the drug to be funded from within a risk-share arrangement which includes a strict financial cap that applies to botulinum toxin.

In April 2020 the PBAC also made a positive recommendation for fremanezumab to be listed on the PBS for the prevention of chronic migraine. Manufacturer Teva Pharma Australia says it is working with the government to enable eligible patients to have access to the drug via the PBS in the near future but no dates can be confirmed.

The update also notes that the application for PBS listing of erenumab was withdrawn by manufacturer Novartis after it was knocked back by the PBAC. From April 2020 a new private prescription process will allow the drug to be accessed at a cost of $695 for a monthly treatment dose via the website migrainedirect.com.au.

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