Session 6 - Nordic reimbursement guidelines for aCGRP treatment

Lars Bendtsen

MD, PhD, Associate Professor, Danish Headache Center, Department of Neurology, Rigshospitalet, Glostrup, University of Copenhagen, Denmark

In Denmark, anti-CGRP monoclonal antibodies can only be prescribed by neurologists working in a Danish hospital (not private practice). Treatment is free for patients and costs are met by the hospital.

Anti-CGRP monoclonal antibodies are prescribed according to national guidelines developed by the Medicinrådet. Eligible patients have chronic migraine that has not responded to treatment with at least one antihypertensive agent and at least one anti-epileptic drug. Medication overuse must be treated before starting therapy and treatment with onabotulinum toxin A must be stopped. The least expensive anti-CGRP monoclonal antibody is the agent of choice unless there are strong reasons for prescribing an alternative. Patients must be closely followed up and headache days, headache severity and use of acute medications must be documented. Treatment must be reviewed after three months and continued only if moderate/severe headache days have been reduced by ≥30%. Effectiveness and adverse effects should be reviewed every three months. Treatment should be paused after one year to determine whether it is still necessary.