Cost control of headache medicines

Glen D Solomon

in Headache care, research and education worldwide

Published on behalf of Oxford University Press

Published in print May 2010 | ISBN: 9780199584680
Published online November 2012 | e-ISBN: 9780191753435 | DOI:

Series: Frontiers in Headache Research Series

Cost control of headache medicines

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  • Neurology
  • Clinical Pharmacology and Therapeutics


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The high expense of headache care includes indirect costs such as loss of work productivity and leisure activities and direct costs such as physician and hospital visits, medication costs, and medical testing. Although medication costs make up one of the smallest portions of the overall expense of headache, it is the segment of expense that often affects the patient most directly. Indirect costs are taken on by society, whereas direct medical testing and physician and hospital visits are generally covered by insurance, government, or third-party payers. Medications must often be paid for directly by the consumer, although sometimes at a price subsidized by insurance or governments.

Although the advent of triptans marked a major advance in migraine therapy, their high cost has limited their widespread use in low- and middle-income countries. Even in wealthy nations such as the United States, the high cost of triptans has led third-party payers to limit availability of these medications.

There are several factors that account for the consumer cost of a medication. In addition to manufacturers’ prices, factors may include import tariffs and taxes, distribution costs, a lack of comparative price data, and mark ups by distributors, pharmacies, and doctors who dispense medications.

The affordability of medications may be improved by increasing the efficiency and volume of production. This process requires robust generic competition and may take years before prices fall. Additional approaches to improve affordability include prescribing the lowest effective dose, clarifying treatment guidelines so that manufacturers can focus on a limited number of drugs, stimulating competition, negotiating with manufacturers, and publicizing the lowest prices. In some nations, government action may also encourage price reductions.

Four options can be considered as potential means to reduce the cost of triptans. These include compulsory licensing, exclusive contracting, Over-The-Counter (OTC) availability, and the introduction of generic triptans.

Chapter.  1637 words. 

Subjects: Neurology ; Clinical Pharmacology and Therapeutics

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