Ensuring Timely Access to Next-Line Migraine Therapies

Zachary Contreras, Director of Pharmacy Benefits at Sharp Health Plan, discussed insights from AMCP Nexus regarding the management of patients with treatment-resistant major depressive disorder (MDD) initiating dextromethorphan-bupropion (DM-BUP).¹ The majority of patients starting DM-BUP had previously received 2 or more antidepressant therapies, highlighting the complexity of this population and the need for earlier identification of treatment resistance to prevent escalating costs and poor clinical outcomes.

Contreras emphasized the potential of predictive and proactive screening tools to identify patients at high risk for treatment-resistant depression. Using patient-reported outcomes, electronic health records, and claims data, clinicians and payers can build predictive models to flag individuals likely to respond poorly to standard therapies. He notZachary Contreras, director of pharmacy benefits at Sharp Health Plan, discussed insights from a study presented at AMCP Nexus regarding strategies to improve timely access to next-line therapies such as monoclonal migraine receptor (MMR) therapy for patients whose migraines do not respond to oral CGRP inhibitors. He emphasized the importance of collaboration between clinicians and payers, noting that streamlined access relies on clear clinical criteria and up-to-date coverage pathways. Consulting with migraine specialists and Pharmacy and Therapeutics (P&T) committees is critical for determining the appropriate positioning of new therapies within formularies and identifying trends that may require coverage adjustments. Involving migraine specialists ensures that payer policies reflect real-world clinical practice, improving both access and patient outcomes.

Contreras highlighted real-time benefit checks as an essential tool for bridging administrative and clinical gaps at the point of prescribing. These systems allow providers to instantly verify coverage status, copays, and prior authorization requirements. If a therapy requires prior authorization, clinicians can communicate expected timelines to patients during the consultation, preventing frustration and delays at the pharmacy. This approach also allows providers to consider alternative therapies based on formulary tier placement, costs, and patient-specific factors, ensuring that patients can start treatment promptly and with full understanding of coverage details.

Overall, Contreras stressed that combining specialist feedback, payer policies, and technology-enabled solutions is critical to facilitating timely access to next-line migraine therapies. Insights shared at AMCP Nexus highlight how these approaches can reduce administrative barriers, improve patient satisfaction, and increase the likelihood that patients receive the right therapy at the right time.