Anti-Migraine Drug Won’t be Subsidised Because it's too Effective and too Many People Need it

A drug that’s proven to reduce the frequency and severity of migraines won’t be listed on Australia’s Pharmaceutical Benefits Scheme (PBS), for fear the medicine would be in such high demand it would cost the Government too much money.

Aimovig—otherwise known as erenumab—is one of the first drugs designed specifically to prevent migraines and reduce their frequency, intensity, and duration. By blocking the body's calcitonin gene-related peptide (CGRP) receptors and preventing CGRPs from attaching to them, the medicine effectively short circuits a chemical process that is thought to be one of the leading causes of migraines. And it works.

Last year, the FDA approved Aimovig alongside two other similar drugs—fremanezumab (Ajovy) and galcanezumab (Emgality)—for use in the United States. Studies found that people taking these medications experienced about half the amount of migraine headache days per month compared with people who weren’t taking them, according to Dr Sait Ashina, a neurologist specialising in headache treatment at the Beth Israel Deaconess Medical Center in Boston.

"I have had very good success with these medications,” Dr Ashina told Harvard Medical School this month. “The majority of my patients with severe migraine headaches are responding well, with few side effects… [and] I have one patient who, for the first time in her life, went 20 days without a headache after starting the new medication."

But these drugs are expensive. In Australia, Aimovig costs patients around $800 a month—and it's estimated that listing it on the PBS would cost the Federal budget a total of $100 million during the first six years, according to the ABC. And it’s this detail that seems to have been a leading factor in the Pharmaceutical Benefits Advisory Committee’s (PBAC) decision to reject the drug twice over the past 12 months.

Their claim, essentially, is this: that there are too many migraine sufferers in Australia, and the ultimate cost to the budget would be “high and uncertain”.

Chair of Migraine Australia’s organising committee, Raphaella Crosby, suggested that the PBAC’s decision was bullying pharmaceutical companies into giving away Aimovig for free—as the drug's Swiss manufacturer, Novartis, has already been doing for the past year through trial programs.

“To deny us a chance at a normal life, confined to welfare or constantly at risk of losing our jobs, unable to have a productive life, simply because there’s too many of us, is cruel and inexplicable,” Ms Crosby said, according to NewsCorp. “It is not clear if the problem is that the PBAC dismiss migraine as ‘just a headache’, or something else, but we are really unhappy about the way we are being treated. It is disrespectful to the millions of Australians whose lives are completely sacrificed to this genetic, incurable disorder, and destroys the first glimmer of hope we’ve ever had.”

Migraines are estimated to affect about 4.9 million Australians—7.6 percent of who are chronic sufferers experiencing more than 15 migraine days per month—and cost the Australian economy $35 billion per year. It is, in many cases, a debilitating condition, and the prospect of chronic pain can make it extremely hard for sufferers to maintain steady work.

Novartis announced this week that they have withdrawn Aimovig from consideration at the November meeting of the PBAC. It will still be available on private prescription at a cost of approximately $800 a month—but it’s unlikely the majority of people who need it will be able to afford it.

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