By Long Tran, PharmD; Beckie Fenrick, PharmD; and Jason Peterson, RPh
Migraine treatment has changed significantly over the past decade. What was once a category managed largely through generic triptans and traditional preventive therapies now includes a growing number of branded, migraine-specific products.
For plan sponsors and the TPAs, brokers and consultants that support them, that shift creates a more complex benefit management challenge: preserving access to clinically appropriate treatment while avoiding unnecessary spend in a rapidly expanding category.
The Workforce and Benefit Costs of Migraine
Migraine is a neurological condition that causes recurring headaches, often accompanied by nausea, sensitivity to light and sound, and visual symptoms. Attacks can last from several hours to several days and may significantly affect a person’s ability to function.
Because migraine often affects working-age adults and can recur over many years, poorly controlled symptoms may interfere with attendance, performance and overall quality of life. Employees may miss work, leave unexpectedly or remain at work while functioning at a reduced capacity. Workplace-focused literature has found that this presenteeism may account for a substantial portion of migraine-related productivity loss.
This creates a dual cost challenge for employers: direct pharmacy and medical costs associated with treatment, and indirect costs tied to absenteeism and reduced productivity.
Understanding Acute and Preventive Migraine Treatment
Migraine treatment approaches are generally divided into two broad categories:
- Acute therapies: used to relieve symptoms at the onset of an attack
- Preventive (or prophylactic) therapies: intended to reduce the frequency, severity, and duration of migraine episodes over time.
Multiple medication classes are used in migraine management, including triptans, ergot derivatives, anticonvulsants, beta-blockers, calcium channel blockers and antidepressants. Patients may use acute therapies, preventive therapies or a combination of both depending on the frequency and severity of their migraines, their prior response to treatment and their individual clinical needs.
What Is Driving Growth in Migraine Pharmacy Spend?
From a payer cost perspective, one of the most important recent developments has been the growth of calcitonin gene-related peptide, or CGRP, targeting therapies.
Given their more targeted mechanism of action and favorable safety profile compared to older therapies, CGRP-targeting therapies have improved migraine care by helping reduce how often attacks happen and improving patients’ quality of life.
However, they also carry substantially higher drug costs than older generic options, making appropriate utilization management essential.
Here are the CGRP-targeting therapies currently on the market:
| Drug | Indication | Route of Administration | Annual WAC |
| Annual WAC | Preventive treatment of migraine | Subcutaneous injection | $9,396 |
| Emgality | Preventive treatment of migraine; episodic cluster headache | Subcutaneous injection | $9,167 |
| Ajovy | Preventive treatment of migraine | Subcutaneous injection | $9,515 |
| Nurtec ODT | Acute treatment of migraine; preventive treatment of episodic migraine | Oral | $12,903 acute; $24,463 chronic |
| Qulipta | Preventive treatment of migraine | Oral | $14,655 |
| Ubrelvy | Acute treatment of migraine | Oral | $10,935 |
| Zavzpret | Acute treatment of migraine | Nasal spray | $19,035 |
| Vyepti | Preventive treatment of migraine | Intravenous infusion | $8,265 |
Annual acute treatment cost is based on eight doses per month for 12 months, or 96 doses per year.
Why Migraine Medication Costs Are Rising
Claims-based research has shown substantial growth in utilization and costs for CGRP monoclonal antibodies. In 2025, Navitus reported a 24% year-over-year net cost trend for migraine products. The increase was driven by increased utilization, higher unit costs and greater use of high-cost CGRP brand agents.
CGRP-targeting therapies have also moved from later-line options to a more prominent role in migraine management. The American Headache Society now recognizes them as a first-line preventive option alongside traditional preventive therapies.
Growth in utilization has also been supported by increased patient and provider awareness, convenient oral and nasal formulations, and the need for alternatives when older therapies are ineffective or poorly tolerated.
For plan sponsors, the priority is ensuring these medications are used for the right patients, at the right point in therapy and with measurable benefit.
Six Strategies for Managing Migraine Medication Costs
| Management Strategy | Recommended Control | Why It Matters |
| Prior Authorization | Confirm diagnosis, treatment intent, migraine frequency, prior therapy use and functional goals. | Ensures high-cost therapies are used for clinically appropriate patients. |
| Step Therapy | Use lower-cost standard treatments first when clinically appropriate, with exceptions when needed. | Supports cost-effective sequencing without creating inappropriate barriers to care. |
| Quantity Limits | Limit acute therapies based on labeled dosing and expected monthly use. | Helps control overuse and unnecessary spend. |
| Continuation Criteria | Track functional improvement, return-to-work progress, adherence and reduced migraine burden. | Ties ongoing coverage to medical necessity and measurable value. |
| Overlap Review | Monitor use of multiple CGRP therapies, multiple acute agents, or CGRP use with Botox or IV infusions. | Reduces duplication, improves cross-benefit visibility and limits avoidable spend. |
| Formulary Strategy | Prefer lower-net-cost products when outcomes are comparable. | Preserves access while promoting cost-effective care. |
Keeping Migraine Strategy Aligned With a Changing Market
Migraine will remain a fast-moving pharmacy category as treatment options expand and CGRP-targeting therapies become more established in care.
For employers, the next step is to look beyond whether these medications are covered and examine how they are performing across the benefit. That means tracking utilization patterns, treatment overlap, member response and total cost closely enough to identify where access is working as intended and where the strategy may need to change. The organizations that manage this category well will be the ones that treat migraine as an evolving clinical and cost-management priority, not a static formulary decision.
As migraine treatment continues to evolve, Navion can help you evaluate utilization, coverage and cost across the category. Reach out to our team to explore where your current strategy may need a closer look.
