CWCI: Migraine Drugs Are Now the Third Most Expensive California Workers’ Comp Drug

OAKLAND, Calif.--(BUSINESS WIRE)--#CWCI--California workers’ compensation spending on Migraine Drugs continues to climb sharply as the use of new, high-cost Calcitonin Gene-Related Peptide (CGRP) targeted medications increases according to the latest prescription data from the California Workers’ Compensation Institute (CWCI).

Although Migraine Drugs still represent less than 1% of all prescriptions dispensed to injured workers in California, their financial footprint has grown dramatically since 2018, and they are now the third most expensive drug group in California workers’ compensation, behind only Dermatological Drugs and anti-inflammatories. The latest update to CWCI’s Prescription Drug Data Application shows that Migraine Drugs’ share of California workers’ compensation prescriptions has been trending up in recent years, but remains relatively small, increasing from 0.2% to 0.9% between 2018 and the first half of 2025, but their share of the total drug spend in the system has soared from 0.5% to 7.5%.

The Institute data show that much of the increase is tied to the CGRP Migraine Drugs, a newer class of medications designed specifically to prevent or treat migraines. Unlike older migraine therapies, many of which are available as low-cost generics, the CGRP drugs are brand-name specialty medications that remain under patent and command significantly higher prices.

The growing use of these drugs in workers’ compensation is challenging for employers, claims administrators, utilization review professionals, pharmacy benefit managers, and attorneys handling work injury claims. While migraines sometimes result from traumatic brain injuries or concussions sustained in workplace accidents, where causation is relatively clear cut, they may also arise following other injuries or be triggered by factors such as light, sound, odors, or stress, where workplace causation is more difficult to determine. Furthermore, once they are accepted as compensable, migraine claims may involve expensive, ongoing treatment that can extend for years, particularly when CGRP drugs become part of a long-term care plan.

CWCI notes that broader healthcare trends are also contributing to increased use of Migraine Drugs, including direct-to-consumer advertising, aggressive pharmaceutical marketing, greater physician familiarity with CGRP drugs, and growing patient demand. In addition, last month several CGRP Migraine Drugs were added to California’s Workers’ Compensation Formulary drug list for the treatment of traumatic brain injuries, which along with evolving clinical recommendations, may increase the likelihood that these drugs will be approved following utilization review or independent medical review.

While Migraine Drugs may provide meaningful relief and improved functionality for some injured workers, the Institute notes that workers’ compensation professionals should keep an eye out for them to make sure they are used appropriately, as the potential side effects, long-term liabilities and growing financial impact of the CGRP drugs should raise questions about alternative therapies, treatment duration, patient screening, long-term outcomes, and cost effectiveness.

CWCI will continue monitoring Migraine Drug utilization and payment trends and provide additional updates through its Prescription Drug Application as new data and research become available.

Bob Young
(510) 251-9470