Registered nurse and pharmacist prescribers can now prescribe the new migraine medications galcanezumab (Emgality), erenumab (Aimovig), fremanezumab (Ajovy) and atogepant (Aquipta). All of these are used to prevent migraine and work by targeting calcitonin gene-related peptide (CGRP), a neurotransmitter implicated in causing migraine attacks.
These medications were added to the lists of prescription medicines for designated prescribers after a public consultation process. The initial consultation from the Ministry of Health proposed adding atogepant and erenumab to the list for registered nurse prescribers and adding atogepant to the list for pharmacist prescribers. We made a submission in September advocating for the addition of galcanezumab and fremanezumab to these lists and asking that all four of the new anti-CGRP medicines be included for both nurse and pharmacist prescribers. We’re delighted to see that our recommendations were accepted.
We proposed that all of these medicines should be added, as all are on Pharmac’s Options for Investment list, which means they’ve been approved for funding, but Pharmac hasn’t been able to find enough money in its budget to actually fund them. However, many people who can afford to pay for them out of pocket are doing so, as they are considered first line migraine preventive treatments in other jurisdictions. They’re much better tolerated than existing options and can be extremely effective, although they don’t work for everyone. The inclusion of fremanezumab on these lists shows forward thinking, as this isn’t yet available in NZ, but is expected to be available soon.
These new medicines generally have mild or minimal side effects and few safety concerns. The monthly injections (erenumab, galcanezumab and fremanezumab – which may also be injected three monthly) have no known drug interactions and don’t require any dose adjustment for age or weight nor for kidney or liver function. Pharmacist and registered nurse prescribers are well placed to demonstrate how to use these injections and oversee their ongoing use.
These prescribers have met specific training requirements from the Nursing and Pharmacy Councils on management of common and long-term health conditions. Migraine certainly fits within this scope of practice and people with migraine in NZ will benefit from improved access to health professionals who can prescribe these new medications. All up, 20 new medicines were added to the pharmacist prescribing list and 211 new medicines to the registered nurse prescribing list, including beta blockers and calcium channel blockers. These are also standard treatments for migraine prevention and are some of the best options for people unable to afford the new medicines.
We remain committed to advocating for our migraine community at every opportunity. Successes like these are important to ensure Kiwis with migraine have access to migraine-specific treatment options and we don’t continue to fall behind other OECD countries.
Please support our ongoing advocacy by partnering with us as a regular donor so we can continue to advocate on your behalf and keep the migraine voice loud in New Zealand.
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