People with episodic migraine who started galcanezumab had 76% lower migraine-related cost increases and were 1.8 times less likely to stop treatment compared to those starting rimegepant over 12 months.
1.8x less likely to discontinueGalcanezumab users were 1.8 times less likely to stop their migraine prevention treatment compared to rimegepant users over 12 months, based on US insurance claims data.
What the researchers found
Over 12 months of follow-up using propensity score-matched cohorts, galcanezumab users had significantly lower cost increases than rimegepant users: 21% lower increase in all-cause total medical and pharmacy costs, and 76% lower increase in migraine-related total costs.
Treatment persistence was also notably better with galcanezumab. The median time to discontinuation (using a >60-day gap definition) was 244.6 days for galcanezumab versus 178.1 days for rimegepant. Galcanezumab users were 1.8 times less likely to discontinue treatment (HR = 1.81, 95% CI: 1.56–2.10, p < 0.0001).
Why it matters
Migraine prevention medications targeting the CGRP pathway are relatively new, and clinicians and patients need real-world data to guide treatment choices. This is the first head-to-head comparison of these two specific therapies, providing practical insights into which option leads to lower healthcare costs and better treatment adherence — factors that directly impact long-term migraine management success.
How the study worked
This retrospective claims analysis used the Merative MarketScan Research Databases from June 2020 to June 2023. Adults with episodic migraine were grouped by whether they initiated galcanezumab or rimegepant. Cohorts were propensity score-matched to balance baseline characteristics. Healthcare utilization, costs, and treatment discontinuation were compared over 12 months using Wilcoxon signed rank tests, chi-square tests, Kaplan-Meier analysis, and Cox proportional hazards models.
What this study cannot tell us
As a retrospective claims analysis, the study cannot establish causation or account for all confounding factors despite propensity score matching. Claims data cannot capture clinical outcomes like migraine frequency reduction. The study was funded by Eli Lilly, the manufacturer of galcanezumab, which may introduce bias. The rimegepant cohort required a quantity threshold of ≥15, which may affect comparability. Clinical effectiveness differences were not directly measured.
How to read the evidence
This is a retrospective observational study using insurance claims data with propensity score matching. While it provides valuable real-world evidence on costs and adherence, it cannot measure clinical efficacy directly and is subject to the inherent limitations of claims-based research.
When this study was published
Published in 2025 using data through June 2023, this is a recent and timely comparison as both medications are still relatively new to the market.
The bigger picture
CGRP-targeting therapies have transformed migraine prevention over the past several years. As more options become available — including monoclonal antibodies like galcanezumab and small-molecule gepants like rimegepant — real-world comparative data becomes essential for informed treatment decisions. This study adds an important health economics dimension to the clinical evidence, suggesting that injectable antibody approaches may offer cost and adherence advantages over oral gepants for prevention.
Questions still open
- Do the cost and adherence advantages of galcanezumab translate to better clinical outcomes like reduced migraine days compared to rimegepant?
- Would patients who discontinue rimegepant due to the every-other-day dosing schedule do better with a monthly injection approach?
- How do these cost comparisons hold up in healthcare systems outside the US with different pricing structures?
Common questions
Which migraine prevention medication costs less over a year — galcanezumab or rimegepant?
Do people stay on galcanezumab longer than rimegepant for migraine prevention?
Read the original research
Healthcare Utilization, Costs, and Treatment Discontinuation in Adults with Episodic Migraine Initiating Galcanezumab Versus Rimegepant: A US Retrospective Claims Analysis.
Advances in therapy, 42(2), 918-934
Citation
Kim, Gilwan; Hoyt, Margaret; Zakharyan, Armen; Durica, Jennifer; Wallem, Alexandra; Viktrup, Lars. (2025). Healthcare Utilization, Costs, and Treatment Discontinuation in Adults with Episodic Migraine Initiating Galcanezumab Versus Rimegepant: A US Retrospective Claims Analysis.. Advances in therapy, 42(2), 918-934. https://doi.org/10.1007/s12325-024-03072-9