Medsafe has approved the migraine medication atogepant (Qulipta) be added to the New Zealand Medicines Schedule. Atogepant is used to prevent migraine and is taken daily as an oral tablet.
In May 2024, Medsafe granted approval for atogepant to be marketed in New Zealand, making atogepant the first gepant medication to be approved in NZ. Medsafe is the government organisation responsible for overseeing medication access in NZ by assessing the safety, efficacy and quality of new medicines. Now this is done, the drug company that makes atogepant (AbbVie) will decide when and how to bring atogepant into the NZ market.
And in a double whammy, on June 2024, Pharmac added atogepant to its Options for Investment list for the treatment of episodic and chronic migraine, along with galcanezumab (Emgality) and erenumab (Aimovig). Pharmac is the government organisation responsible for deciding which medicines will be publicly funded. By adding these medications to the Options for Investment list, this means that Pharmac considers that atogepant (and galcanezumab and erenumab) should be funded. However, when they are funded depends on the pharmaceutical budget that Pharmac is given by the Government, negotiations with the manufacturers and the priority of other medications on the Options for Investment list. Pharmac has reported that “during the 2022/23 financial year, applications received in the last 5 years took an average of 27.7 months to go from being accepted to a decision being made on whether to fund them.” However, they note that they are ranking more medications for funding than ever before, so this timeframe is likely to lengthen unless more Government funding is made available.
Previously, medications could not be assessed by Pharmac until after Medsafe approval was granted. However, atogepant was assessed by Pharmac’s Neurological Advisory Committee in September 2023, while atogepant was still going through the Medsafe process. This is a great example of how allowing the Pharmac and Medsafe assessment processes to occur in parallel will reduce the time needed for a new medication to obtain a funding assessment by Pharmac. If AbbVie had not been allowed to make an application to Pharmac until the Medsafe approval was granted, we would not have atogepant now sitting on the Options for Investment list – this application would only now be able to be made. Considering that the application to Pharmac for erenumab was made in February 2021 and we made an application for galcanezumab in November 2022, this could have added years to atogepant’s funding journey. This parallel assessment was announced to be a permanent change to Pharmac’s process in February 2024.
About gepants
Gepants are a new oral medication specifically developed for migraine. Four gepants are approved overseas:
- Atogepant (Qulipta)
- Ubrogepant (Ubrelvy)
- Rimegepant (Nurtec ODT)
- Zavegepant (Zavzpret)
Gepants are a type of calcitonin gene-related peptide (CGRP) inhibitor, targeting the same peptide as the injectable CGRP medications available in New Zealand, Aimovig and Emgality.
Gepants were originally developed to treat a migraine attack, much like triptans. However, atogepant (Qulipta) was developed for use as a migraine preventive medication, taken daily, and rimegepant (Nurtec) has also been approved for migraine prevention when taken every other day.
Early indications suggest that gepants aren’t associated with medication overuse headache. Many people with migraine struggle with medication overuse headache, which can occur when a person takes too many acute medications to treat migraine over a period of at least three months. Medication overuse headache is not the fault of a person with migraine, but a sign that there is a huge need for migraine medication options specifically designed for migraine with an improved safety profile. Gepants may be one of these options.
