Comparative Review of Migraine Therapeutics Coverage Across 3 Major Health Plans

As migraine therapeutics evolve from legacy triptans to high-cost, targeted CGRP agents, payers face the challenge of balancing clinical innovation with cost containment. Our latest Formulary Frontlines analysis compares how Blue Cross Blue Shield, Cigna, and UnitedHealthcare manage coverage across key migraine treatment classes, revealing striking differences in tiering, utilization management, and access philosophy.

Key Insights

• BCBS provides the most favorable access, placing cornerstone triptans in Tier 1 and listing preventive CGRP monoclonal antibodies such as Aimovig and Emgality at Tier 2 with prior authorization, signaling support for self-administered, cost-mitigated preventive care.
• Cigna enforces the tightest controls, clustering CGRP agents and gepants in higher tiers with layered restrictions—including PA, quantity limits, and non-extended day supply—limiting access to patients who have failed lower-cost options.
• UnitedHealthcare employs a selective, contract-driven approach, assigning most CGRP agents and gepants to Tier 4 or 5 with consistent PA and dispensing limits, while maintaining lower-tier access to generic triptans for acute management.

What You'll Gain

• Side-by-side formulary comparisons across 4 migraine therapy categories—CGRP monoclonal antibodies, gepants, triptans, and onabotulinumtoxinA—detailing how coverage, tiering, and restrictions vary across plans.
• Clear visibility into payer strategy, showing how prior authorization, quantity limits, and dispensing controls shape access to acute and preventive migraine therapies.
• Strategic insights to inform formulary design, highlighting how major payers balance affordability, innovation, and patient access in a rapidly expanding specialty market.

Download the full report to benchmark your migraine formulary strategy in a landscape where generics remain widely accessible, but novel CGRP-targeted treatments face stringent access hurdles.