New Study: Payer Blocking Strategies Delay Care for One in Five Migraine Patients

WASHINGTON, Feb. 4, 2026 /PRNewswire/ -- Insurance restrictions that delay or deny access to migraine medication are linked to an increase in emergency department visits and hospitalizations. A new study found that payer blocking strategies such as step therapy and prior authorization predominantly affect people with lower incomes and education levels. Key study findings include:

• Denial rates for branded migraine therapies varied widely across 1,290 managed care organizations and payers – ranging from 0% to 66%.
  
  
• Payer blocking as defined in this study affected approximately one in five patients, was more common among patients with lower income and education and varied by race and ethnicity – all differences were statistically significant although effect sizes were small.
  
  
• Patients with a history of payer blocking were significantly more likely to visit the emergency department and/or be hospitalized for migraine-related or other health issues.

"These findings confirm what patients and providers have long understood: payer blocking strategies are real obstacles to timely, effective care," said Kristen Santiago, executive director of The Headache & Migraine Policy Forum. "When one in five people with migraine faces delays or denials for proven treatment, the result is more emergency visits, higher costs, and unnecessary suffering."

The observational cohort study analyzed claims from 370,560 migraine patients treated between January 2019 and December 2021 who were prescribed branded acute and/or preventive medications. Data sources included electronic health records, emergency department visits, specialty pharmacies, and in-office dispensing. The Headache & Migraine Policy Forum defined "payer blocking" as two or more denials related to step therapy, prior authorization, or similar restrictions. The analysis examined differences by race and ethnicity, income, and education, and assessed whether repeated payer blocking was linked to increased health care utilization.

"The good news is that migraine treatments have never been better, with CGRP-targeted therapies proving highly effective and well tolerated," said Richard B. Lipton, MD, study author and professor and vice chair of neurology at the Albert Einstein College of Medicine. "Yet this study shows a clear gap between clinical guidelines and real-world access, as insurance barriers continue to delay or block these recommended treatments."

Currently, all preventive medications developed specifically for migraine are branded, and no generic versions exist.

The urgency of this issue is underscored by a recent position statement from the American Headache Society, which supports calcitonin gene-related peptide (CGRP) targeting therapies as first-line options for migraine prevention. Patients should not have to be failed by preventive treatments that were not developed for migraine before accessing these effective therapies – yet payer blocking often forces them to do just that.

"When one in five patients faces repeated denials for prescribed medications, the result is more emergency visits, hospitalizations, and suffering," said Dawn C. Buse, PhD, lead author and clinical professor of neurology at Albert Einstein College of Medicine. "These insurance barriers don't just delay care — they undermine quality of life, especially for those with fewer resources. Reducing them is essential to improving migraine outcomes."

About The Headache & Migraine Policy Forum

The Headache & Migraine Policy Forum is a national non-profit coalition of two dozen stakeholder members whose mission is to advance public policies and practices that promote accelerated innovation and improved access to treatment for persons living with headache disorders and migraine disease.

SOURCE The Headache & Migraine Policy Forum