{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:30:30Z","timestamp":1791862230851,"version":"4.3.4"},"reference-count":34,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["headachejournal.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Headache"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine if insurers updated formularies and step therapy requirements after the American Headache Society's (AHS) March 2024 consensus statement for the prevention of migraine that changed calcitonin gene\u2010related peptide (CGRP)\u2013targeted medications to first\u2010line treatments, and if there was an associated expansion in patients prescribed these medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insurance company formularies and step therapy requirements should ideally mirror the recommendations provided by the AHS. The AHS' March 2024 consensus statement for medications for the prevention of migraine made CGRP\u2010targeted medications first\u2010line treatments, removing the recommendation for first pursuing two 8\u2010week trials of non\u2010specific oral medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study using the Epic Cosmos electronic health record database, insurance formulary, and step therapy information. The Epic Cosmos research platform was queried for patients with migraine and prescriptions for the CGRP\u2010targeted medications by month from May 1, 2023, to January 31, 2025. Our primary outcomes were the time\u2010trend in the prescription of the CGRP\u2010targeted therapies during the study interval and whether there was an immediate increase in patients using CGRP\u2010targeted medications or change in the rate of utilization after the March 2024 AHS consensus statement. Secondary outcomes included this analysis for patients with chronic migraine, based on care setting, and with the post\u2010release period broken into early and late phases. Insurance formularies and step therapy requirements were reviewed for coverage of the CGRP\u2010targeted medications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our study included 6,898,995 patients with migraine and 929,793 patients with chronic migraine. During the study period, prescriptions for all CGRP\u2010targeted preventive medications by all providers showed statistically significant increases, excluding erenumab, which was unchanged. For none of the queried CGRP\u2010targeted medications in the main analysis, was the AHS consensus statement's release linked to an increase in their usage. Conversely, for patients with chronic migraine, in the non\u2010neurology setting, a small immediate increase was seen for fremanezumab, erenumab, and atogepant, but this was offset by a subsequent slowing of the overall rate of increase in their utilization in this setting (\u22120.07 percentage point change in rate of uptake for any CGRP\u2010targeted medication by month; 95% confidence interval, \u22120.10 to \u22120.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Although insurance coverage for at least one of the CGRP\u2010targeted medications was high (142 of 149 plans, 95.3%), individual medication coverage varied with 126 of 149 (84.6%) of plans covering galcanezumab but only 93 of 149 (62.4%) covering atogepant. Step therapy requirements including trials of non\u2010specific oral medications before starting CGRP\u2010targeted therapies were largely in place 10 months after the consensus statement release.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Ten months after the American Headache Society's March 2024 consensus statement made the CGRP\u2010targeted medications first\u2010line for the prevention of migraine, insurance companies have had incomplete compliance with the recommendations, potentially limiting the full impact of the AHS' consensus statement on the utilization of the CGRP\u2010targeted therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.15027","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T14:05:20Z","timestamp":1753711520000},"page":"801-812","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["The state of insurance coverage of calcitonin gene\u2010related peptide\u2013targeted medications and its impact on the implementation of the American Headache Society's 2024 consensus statement: An interrupted time\u2010series analysis"],"prefix":"10.1111","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8596-9130","authenticated-orcid":false,"given":"Leon S.","family":"Moskatel","sequence":"first","affiliation":[{"name":"Department of Neurology Stanford University  Palo Alto California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J. G.","family":"Slusky","sequence":"additional","affiliation":[{"name":"Department of Economics University of Kansas  Lawrence Kansas USA"},{"name":"National Bureau of Economics Research  Cambridge Massachusetts USA"},{"name":"IZA Institute of Labor Economics  Bonn Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182535d20"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2012.02185.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14153"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/03331024231152169"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/head.14692"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.04.041"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1E121"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/hr.2012.216"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0041-1731004"},{"key":"e_1_2_9_11_1","unstructured":"Epic Cosmos About"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnaf038"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/1536867X1501500208"},{"key":"e_1_2_9_14_1","volume-title":"Time Series Analysis: Forecasting and Control","author":"Box GEP","year":"1976"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/0193841X8300700408"},{"key":"e_1_2_9_16_1","unstructured":"Accessed January 9 2025.https:\/\/www.bluecrossmn.com\/sites\/default\/files\/DAM\/2020\u201009\/P11GA_12937323.pdf"},{"key":"e_1_2_9_17_1","unstructured":"Accessed January 9 2025.https:\/\/providers.anthem.com\/docs\/gpp\/PHARM_ALL_Aimovig.pdf?v=202101061832"},{"key":"e_1_2_9_18_1","unstructured":"Accessed January 9 2025.https:\/\/www.va.gov\/formularyadvisor\/DOC_PDF\/CFU_Erenumab_AIMOVIG_for_episodic_migraine_Criteria_rev_Aug_2024.pdf"},{"key":"e_1_2_9_19_1","volume-title":"Digital Collections","author":"Alaska State Libraries A"},{"key":"e_1_2_9_20_1","volume-title":"Propranolol: Drug Information"},{"key":"e_1_2_9_21_1","volume-title":"Galcanezumab: Drug Information"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2017.23.11.1169"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2011.01945.x"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-021-01335-2"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414547138"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000203041"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.18553\/jmcp.2022.28.8.818"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-022-01431-x"},{"key":"e_1_2_9_29_1","unstructured":"Accessed January 26 2025.https:\/\/www.va.gov\/formularyadvisor\/"},{"key":"e_1_2_9_30_1","volume-title":"Welcome to the Clinical Criteria Page"},{"key":"e_1_2_9_31_1","volume-title":"Anti\u2010Migraine Policy"},{"key":"e_1_2_9_32_1","unstructured":"CP.PHAR.403. 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