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Expectations for the Future Management of Migraine


Peter L. Salgo, MD: What’s the future of insurance coverage for migraine therapy?

Malaika Stoll, MD, MPA: I think we’re headed in the right direction. I was encouraged by the conversation today, and I hope that we continue to partner. I think that’s what health plans need to do most: Partner with providers, patients, and patient advocates to make sure that we’re covering the right things for the right people.

Peter L. Salgo, MD: What do you want her to do? What do you want anybody to do to improve patient care?

Jill Dehlin, RN: I want them to listen to us, plain and simple.

Peter L. Salgo, MD: That’s easy, right?

Jill Dehlin, RN: No, not really.

Peter L. Salgo, MD: It’s hard to listen to people.

Malaika Stoll, MD, MPA: Dr Stoll is easy to talk to.

Peter L. Salgo, MD: Well, yes, but not everybody is. In the little time that we’ve got left, I’d like to ask everyone to share 1 little thought about what you’d like to see or what your views are on all of the things that we’ve been discussing. Ms. Dehlin?

Jill Dehlin, RN: I would like to comment that patient advocacy is a really important field because people who have migraine disease and other headache disorders often feel left out of the conversation. I think education is a really important part of helping people with migraine disease—not only patients but their caregivers. I would like to add that it’s important that physicians, physician assistants, nurse practitioners, and others in the medical field have a greater knowledge of exactly what is happening with people with migraine because it is still a very stigmatized disease. And finally, I would like to say that my moonshot, as Dr. Goadsby called it, the holy grail, is to have a tailored approach to migraine and not the Guinea pig approach that we have now.

Peter L. Salgo, MD: Dr Goadsby?

Peter Goadsby, MD, PhD: From my perspective, it’s an incredibly exciting time to be in headache medicine as a neurologist, particularly in migraine and in cluster headache. We’ve seen the partnership of the American Headache Society with the American Migraine Foundation patient advocacy group and the American Academy of Neurology. We recognize that if we train neurologists and physicians better, we can do better. We talked about a number of new approaches. We talked about these monoclonal antibodies. We talked about neuromodulation approaches. We talked about noninvasive vagus nerve stimulation and single-pulse transcranial magnetic stimulation. But we didn’t even touch upon other things that are happening. Small molecule CGRP [calcitonin gene-related peptide] receptor antagonists, the so-called gepants, will be a new acute therapy. The serotonin 1F receptor agonist lasmiditan is another option. And a small molecule medicine, atogepant, is moving into prevention. It’s an incredibly exciting time to be able to develop this range of therapies to really offer something to people who have had such a disabling problem. I’m encouraged by a partnership with advocates. I am encouraged by a partnership with payers to really move the dial on something that’s been so horrible for so many for so long.

Peter L. Salgo, MD: Dr. Stoll, you’ve got the last word.

Malaika Stoll, MD, MPA: I’m really grateful. I learned so much from everybody today, and I think that’s what, as a health plan, we need to do—listen and learn from those around us. Also, as a health plan, our responsibility is to assure access for our members for behavioral health and medical care. At Blue Shield of California, we’re doing a lot of work in telehealth and are trying to expand our network. So, it was great to be here. I appreciate it.

Peter L. Salgo, MD: What a great discussion. I want to thank all of you for joining us today. On behalf of our panel, I want to thank you for following this American Journal of Managed Care® Migraine Peer Exchange series. I hope you found this Peer Exchange to be useful and informative. I’m Dr Peter Salgo, and I’ll see you next time.

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