TABLE 1

Current calcitonin gene-related peptide (CGRP) antagonists

Drug	Mechanism	Dosing and frequency^a	Most common adverse effects^a	Average wholesale price and Pharmaceutical Assistance Program^a
Erenumab	CGRP receptor antagonist	Migraine: 70 or 140 mg subcutaneously, monthly	Injection site erythema or pain, 5%–6% Constipation, 3%	$690 per month (regardless of dose) If commercial insurance plan does not cover or requires prior authorization, patients are eligible for 12 doses over 24 months with a $5 copay card per month; maximum benefit $2,700 annually
Fremanezumab	CGRP ligand antagonist	Migraine: 225 mg monthly or 675 mg every 3 months subcutaneously	Injection site reaction, 45%	$690 per 225-mg syringe Patients with commercial insurance plan are eligible for 12 months of treatment with a $0 copay card; there is no annual maximum benefit; with electronic coupon, copay is $20
Galcanezumab	CGRP ligand antagonist	Migraine: 240 mg, then 120 mg per month subcutaneously Cluster headache: 300 mg at onset of cluster period, then monthly until end of cluster headache	Injection site reaction, 18%	$690 per 120-mg autoinjector If commercial insurance plan does not cover or requires prior authorization, patients are eligible for a $0 copay card; maximum coverage is $4,900 annually As of 2020, this benefit is available only after prior authorization is approved by insurance
Eptinezumab	CGRP ligand antagonist	100 mg/mL or 300 mg/mL via infusion every 90 days	Nausea, 1.6% Fatigue, 1.4%	$1,495 per infusion ($5,980 per year)

↵a Information from product package inserts and personal communication with Cleveland Clinic Adherence Specialty Pharmacy.