Advocacy Toolkit 2026

Every year, Pharmac (the Government’s medicine buying agency) receives many more applications for publicly funded medicines than its budget allows it to fund. Once each application has gone through Pharmac’s Health Technology Assessment process it’s then ranked from highest to lowest priority, and once prioritised it’s added to one of 3 lists: options for investment; only if cost neutral or saving; application for decline.

The Options for Investment (OFI) list is the list of medications Pharmac would fund if it had the budget to do so.

Pharmac keeps the actual rankings on the OFI list confidential for commercial reasons. This is to help Pharmac negotiate better prices with pharmaceutical companies.

This list is not a “maybe.” It’s a queue. Pharmac has assessed these medications as being worthy of funding but Pharmac is unable to fund them because its budget is capped. Until the government increases investment into Pharmac, people with migraine and other conditions with medications on the OFI list wait and miss out on medications that should be funded.

Learn more about Pharmac’s prioritisation here

Four modern migraine preventive medicines are currently on the OFI list. All four medications target a small protein called calcitonin gene-related peptide (CGRP), which is involved in the cascade of events that lead to a migraine attack.

For many people living with chronic and episodic migraine, these medicines can dramatically:

• reduce attack frequency and severity
• restore ability to work
• improve mental wellbeing
• reduce pressure on the health system, including less visits to primary care.

But in New Zealand, because these medications aren’t publicly funded, access depends on whether you can afford to pay privately.

This is not equitable healthcare.

The four anti-CGRP medications on the OFI list are:

• Fremanezumab (Ajovy)
• Atogepant (Aquipta)
• Galcanezumab (Emgality)
• Erenumab (Aimovig)

Fremanezumab (Ajovy)

Ajovy became available in New Zealand in January 2026.

Ajovy is self-administered by subcutaneous injection (an injection just under the skin). However Ajovy is the only injectable with two dosing options – either one injection (225mg) once a month, or three injections (675mg) every three months. Ajovy doesn’t require a loading dose.

Ajovy is available via prescription. General Practitioners and Nurse Practitioners can prescribe Ajovy, a prescription from a neurologist isn’t needed. It can be initiated by a physician experienced in the diagnosis and treatment of migraine.

Ajovy costs around $300–$330 per 225mg/1.5ml injection. It can be ordered by any pharmacy in New Zealand.

Atogepant (Aquipta)

Aquipta became available in New Zealand in October 2024.

Aquipta is a once a day oral tablet. Ajovy is available via prescription. General Practitioners and Nurse Practitioners can prescribe Ajovy, a prescription from a neurologist isn’t needed. It can be initiated by a physician experienced in the diagnosis and treatment of migraine.

Aquipta is available through Airport Oaks Pharmacy and costs $352.80 for a one month supply (28 x 60mg tablets).

Galcanezumab (Emgality)

Emgality became available in New Zealand in August 2022.

Emgality is self-administered by subcutaneous injection (120mg/1ml). Two injections (240mg) are given as a first, loading dose, and then one injection every 4 weeks. Emgality is available via prescription. General Practitioners and Nurse Practitioners can prescribe Emgality, a prescription from a neurologist isn’t needed. It can be initiated by a physician experienced in the diagnosis and treatment of migraine.

Each 120mg/1ml injection costs on average $325 but costs vary depending on the pharmacy.

Erenumab (Aimovig)

Amovig became available in New Zealand in 2021.

Aimovig is self-administered by subcutaneous injection as either 70mg or 140mg.

Aimovig is available via prescription. General Practitioners and Nurse Practitioners can prescribe Aimovig, a prescription from a neurologist isn’t needed. It can be initiated by a physician experienced in the diagnosis and treatment of migraine.

A 70mg injection costs $678 and 140mg costs $1,356. Aimovig is available through Grafton Pharmacy in Auckland.

CGRP is a small protein involved in the cascade of events that lead to a migraine attack. CGRP helps transmit pain signals in the brain, ramp up inflammation and dilate blood vessels. The CGRP monoclonal antibodies (anti-CGRP medications) block this protein, by either binding to CGRP itself or binding to the receptor sites found in some parts of the nervous system such as the trigeminal nerve, effectively turning off its ability to stimulate the neurological dysfunction that is a migraine attack.

Anti-CGRP medications are the first medications developed specifically to prevent migraine. Prior to their development, the only preventive medications used for migraine were medications developed for other conditions, such as depression, epilepsy and high blood pressure, that were found to be useful to prevent migraine.

Anti-CGRP medications are a significant development in migraine treatment. They’ve been found to be safe and effective, with fewer side effects than many other preventive migraine medications.

Ajovy, Emgality and Aimovig are CGRP monoclonal antibodies and are a once a month self-injection. Ajovy also has the option to use quarterly, with three injections four times a year.

Aquipta is a gepant medication. Gepants are another class of medication that targets calcitonin gene-related peptide (CGRP). Although initially developed as acute medication to treat migraine attacks, some gepants have been found to be effective in prevention of migraine. Gepants that are used to treat migraine attacks can be a good option for people who can’t take or tolerate triptans, or for whom triptans don’t work. In addition, gepants are not associated with medication overuse headache so are useful for people with chronic migraine.

Aquipta is an oral medication, taken daily, for the prevention of episodic and chronic migraine.