Rates and healthcare resource utilization for people with branded acute and preventive migraine prescription medication order payer denials: An open, multi‐source dataset, observational cohort study

Objective This study was undertaken to report rates of payer blocking of prescribed branded migraine medications in total and by race/ethnicity, income, and education, and to examine the relationship between payer blocking and emergency department and inpatient encounters for migraine‐specific and all‐cause reasons in a large US claims database. Background Access to prescribed branded migraine medications can be challenging due to restrictive utilization management protocols and may be related to increased healthcare resource utilization. These barriers may disproportionately affect patients based on sociodemographic factors. Methods This observational cohort study analyzed data from an integrated database containing electronic medical records, specialty pharmacy, and in‐office dispensing datasets. Individuals with a migraine diagnosis who experienced payer blocking —defined as denial of prescribed branded migraine medications ≥2 times due to step therapy, prior authorization, or related restrictions—between January 1, 2019, and December 31, 2021, were included. Rates of payer blocking were reported for the total sample and by sociodemographic groups. Emergency department (ED) and inpatient encounter rates for migraine‐specific and all‐cause reasons were compared by payer blocking status. Differences were assessed using χ 2 tests with Bonferroni corrected α ( p < 0.0018). Effect sizes were estimated using Cramer's V . Results Among 7.7 million patients with ≥1 migraine‐related prescription claim(s), 370,560 actively treated individuals met inclusion criteria for analysis. One in five (20.6%) experienced payer blocking. There were significant differences in the distribution of race/ethnicity, annual household income, and educational attainment categories across payer blocking status groups ( p < 0.001 for all), with small effect sizes (Cramer's V = 0.014–0.034). Patients with a history of payer blocking had significantly higher rates of ED and inpatient encounters for both all‐cause and migraine‐specific reasons ( p < 0.001 for all), although effect sizes were small. This pattern was consistent within racial/and ethnic groups, with significant differences observed for White patients both for migraine‐related and all‐cause ED and inpatient encounters, and Black/African American and Hispanic/Latino patients for migraine‐related encounters ( p < 0.001 for all). Conclusion Payer blocking of branded migraine medications was fairly common, affecting one in five patients and was broadly associated with increased healthcare utilization. These findings suggest that payer blocking may disproportionately impact patients according to race/ethnicity, l household income,‐ and educational attainment. Although effect sizes were small, the outcomes may provide useful hypotheses for understanding and addressing healthcare disparities in migraine.