Field Reimbursement Managers and Qulipta

Field Reimbursement Managers and Qulipta

Qulipta is an indicated CGRP receptor antagonist used for the prevention of episodic migraines. The American Headache Society (AHS) and European Headache Federation (EHF) recommend trialing a CGRP receptor antagonist or CGRP-targeted mAb when patients have failed at least two standard-of-care preventive treatments. The options for second-line treatment include Qulipta (Atogepant), and its competitors Nurtec ODT (Rimegepant), Aimovig (Erenumab), Ajovy (Fremanezumab), Emgality (Galcanezumab), and the first IV formulation Vyepti (Eptinezumab).

Qulipta offers the advantage of a longer half-life, making it well-suited for preventative care. Similar to Nurtec, Qulipta is an oral treatment, providing easier administration compared to the subcutaneous or IV injection routes required for other medications. However, a potential downside of oral dosing is the need for daily administration, which can increase the risk of non-adherence. Another drawback is the pricing, although it is worth noting that all of these medications are generally expensive and fall within a similar cost range. Qulipta, being a more recently developed option, is currently limited to preventive treatment. These factors may contribute to its slower adoption, as healthcare providers may have more experience prescribing other drugs and are familiar with the requirements for obtaining proper reimbursement and coverage for alternative options in preventative migraine treatment within their practices.

A potential solution to assist Qulipta in this scenario is the presence of a Field Reimbursement Manager (FRM). Field Reimbursement Managers (FRMs) are skilled professionals who operate in a specialized non-sales capacity. Their role involves engaging with healthcare providers and their office staff to provide assistance and support in helping patients access the medication that their provider has determined to be the most suitable treatment option. They have extensive knowledge of insurance coverage and patient assistance programs and can deliver information on reimbursement, payer access, and HUB services. While this service may not directly interact with patients, its value lies in equipping healthcare providers with the necessary tools to overcome any barriers that might hinder them from prescribing the required medication to their patients. The support and services provided by the Field Reimbursement Managers (FRMs) are delivered on a one-on-one basis to the providers, offering them benefits in their practice as well.

FRMs duties are to improve payer access to high-cost, specialized medications, facilitate product fulfillment, address claim denials, coordinate appeals processes, and verify the information on intake forms. By leveraging the expertise of a Field Reimbursement Manager (FRM), Qulipta has the potential to overcome the obstacles that currently prevent it from surpassing its competitors and becoming the preferred prescribing option for healthcare providers and their patients in need of episodic migraine prevention. The support and guidance provided by the FRM could lead to significant improvements in the adoption and utilization of Qulipta, ultimately benefiting both providers and their patients.