News & Insights
Utilization and Adherence Patterns of CGRP Abortive Therapies
By Sara Chea, PharmD; Stephen Kang, PharmD; Jeffrey He, PharmD, APh
Calcitonin gene related peptide (CGRP) receptor antagonists have expanded abortive treatment options for patients with migraine who do not tolerate or adequately respond to traditional therapies. According to the 2025 International Headache Society (IHS) evidence based guidelines, rimegepant, ubrogepant, and zavegepant are strongly recommended for acute migraine treatment based on high quality of evidence. However, there is limited real world data are available to characterize their utilization and persistency
To better understand real-world use patterns, Ventegra’s 2025–2026 Managed Care Fellow, Sara Chea, PharmD, and our clinical team conducted a retrospective claims-based analysis evaluating persistency trends for three guideline-recommended CGRP abortive therapies—rimegepant, ubrogepant, and zavegepant. The study analyzed January to December 2025 pharmacy claims data for patients newly initiated on a CGRP abortive therapy, with a six-month follow-up period to assess refill behavior.
Persistency was evaluated using the number of paid claims and refills as surrogate markers of treatment continuation and patient-perceived effectiveness. Across all three agents, the analysis demonstrated low persistency beyond the initial fill. Prior authorization data showed a majority of discontinuations were attributed to patient-perceived ineffectiveness.
These findings highlight the importance of incorporating real-world evidence alongside clinical guidelines when evaluating CGRP migraine therapies. Understanding utilization and persistency patterns of CGRP abortive agents may help guide patient education efforts and support optimized utilization management strategies for managed care organizations.
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