Session 6 - Nordic reimbursement guidelines for aCGRP treatment

Ingela Nilsson Remahl

MD, PhD, Head of the Headache Center, Karolinska University Hospital

An anti-CGRP monoclonal antibody may be prescribed for patients with chronic migraine for whom at least two preventive treatments have proved unsuccessful. Patients must keep a migraine diary for the 2–3 months preceding and following initiation using the Swedish Headache Register. Treatment may only be prescribed by a neurologist or physician working at a headache clinic who has experience of treating patients with severe migraine. Treatment must be evaluated after three months and continued only when a ≥30% reduction in migraine days has been achieved. It should then be re-evaluated every 12–18 months. Galcanezumab is recommended as the agent of first choice (at the time of this presentation, 28 November 2020).

In Sweden, all residents have a right to treatment regardless of where they live, their income or their social status but how this obligation is implemented varies between the six health care regions and 21 councils, and also between hospitals. Patients pay the first 2,350 SEK per year of medicines costs, after which they receive full reimbursement. The Swedish Headache Society is currently developing uniform treatment criteria to ensure equal access across Sweden.