Amgen and Novartis had a first-mover advantage in the new class of calcitonin gene-related peptide (CGRP) migraine prevention drugs with their Aimovig (erenumab) getting FDA approval in May 2018. However, the exclusion of Aimovig by American prescription benefits manager CVS Health Corp from the list of covered drugs is a setback to its sales, says GlobalData, a leading data and analytics company.

The migraine market had a landmark year in 2018. Aimovig secured the first-to-market position following its FDA approval in May 2018. Teva’s Ajovy (fremanezumab) and Eli Lilly’s Emgality (galcanezumab) rapidly followed suit, with both drugs receiving FDA approval in September 2018. Unexpectedly, all three rival drugs launched at the same price point, with a list price $6,900 per year.

According to GlobalData, the global migraine drug sales could reach $8.7bn by 2026 and the US will continue to dominate the market with a 77% share of total sales in the seven major markets (7MM*).

Maura Musciacco, Director of Neurology and Ophthalmology at GlobalData, comments: “Winning preferred status by pharmacy benefits managers is considered a crucial step for new drugs, and given that the CVS pharmacy benefit manager business covers 93 million people in the US, its decision is a blow to Amgen and Novartis, especially as they gained the first mover advantage, albeit for a short period of time. Now patients who rely on the coverage list will have easier access to the rival Ajovy and Emgality.”

The similarity between the three drugs in terms of efficacy, safety, closeness to launch, and even price means that differentiation is limited, aside from Ajovy’s quarterly and monthly dosing options while Aimovig and Emgality are both administered once a month. Given CVS’ decision, it means that the battle for the leading CGRP antagonist drug is still wide open.

Musciacco concludes: “It is likely that CVS’ decision could be a carrot-and-stick strategy to force Amgen and Novartis to offer better discounts or rebates in return for positive formulary placement. As such, 2019 will be a decisive year for these three CGRP antagonists as we see the results of reimbursement decisions, and with the upcoming launch of a fourth CGRP antagonist, Alder’s epitinezumab, the migraine market is expected to see even more challenges and competition.”

*7MM: The US, France, Germany, Italy, Spain, the UK and Japan