Korea’s strict CGRP rules leave migraine patients far behind Japan, experts warn

Because of Korea’s rigorous health insurance reimbursement criteria for CGRP (calcitonin gene-related peptide) treatments, migraine patients face lower treatment accessibility than those in Japan.

The reimbursement rate for CGRP treatments effective against migraines is only 5 to 15 percent of patients. Experts emphasize that expanding health insurance coverage is urgently needed to alleviate patients' suffering.

To address these concerns, the Korean Headache Society (KHS) held a press conference on Sunday to commemorate its Fall Academic Conference and Korea-Japan Symposium, and to explain the Korean migraine treatment environment and global shifts in treatment paradigms.

"When comparing migraine treatment in Korea and Japan, CGRP monoclonal antibody therapy is equally effective. However, Korea's insurance coverage is the world's strictest, creating a significant gap in accessibility," said KHS President Chu Min-kyung, also a neurology professor at Severance Hospital.

According to CGRP monoclonal-antibody treatment data from both countries presented at the symposium, the response rate for episodic migraine patients was approximately 50 percent, and for chronic migraine patients, around 40 percent, showing nearly identical levels. Adverse event reports also showed similar frequencies and patterns in both countries, indicating that the drug's safety and efficacy differ little between nations.

However, when focusing specifically on accessibility to CGRP therapy under insurance-coverage criteria, stark differences emerged between Korea and Japan.

The reimbursement criteria in Japan are as follows: Coverage is possible after failure of one existing preventive medication; both episodic and chronic migraine are covered; and CGRP monoclonal-antibody treatments can be used without restriction.

In contrast, the comparable criteria in Korea stipulate that coverage is available only after failure of three or more preventive medications at maximum dosage for at least six months, and coverage is limited to chronic migraine. Furthermore, reimbursement is approved for only one year, followed by a mandatory six-month break. If a patient switches to another CGRP treatment due to lack of efficacy, reimbursement is not granted.

“Korea maintains stricter criteria than even the U.K.'s initial model, resulting in a reimbursement coverage rate for CGRP treatments of only 5 to 15 percent of all patients,” Chu said. “To alleviate patients' suffering, reimbursement criteria need to be expanded, such as reducing the drug-free period from six months to three months.”

Earlier in the meeting, the KHS head also explained the recommendations announced by the International Headache Society (IHS) this year.

The IHS established and published recommendations this year to set an active prevention goal of reducing headache days to four or fewer per month, and to initiate preventive treatment at the earliest possible stage to suppress disease progression.

Professor Chu explained, “Recent studies have found that preventive treatment not only reduces headache frequency but also modifies the disease’s natural course, potentially stopping disease progression in advance. Despite these findings, Korea's current standard, which allows CGRP use only after roughly six months of treatment failure, stands in marked contrast to international recommendations.”

Notwithstanding this, Chu expressed optimism about recently introduced drugs. She noted that fremanezumab, a CGRP-targeted pediatric migraine treatment, was approved in the U.S. in August and is awaiting domestic approval. Pfizer's oral CGRP inhibitor Nurtec received approval from the Ministry of Food and Drug Safety (MFDS) in March 2024 and is preparing for launch.

“New treatment options will mark a turning point for migraine management,” Chu said. “The KHS will keep working to improve reimbursement rules.”