A migraine prophylaxis educational intervention in a Medicaid population

To assess migraine prophylactic drug utilization in the Idaho Medicaid population and to evaluate responsiveness of practitioners to an educational intervention from the Idaho Medicaid Drug Utilization Review (DUR) Program.

While established guidelines recommend migraine prophylactic therapies for defined patient populations and several drugs have demonstrated efficacy, their actual utilization is reportedly low.

Profiles for Idaho Medicaid patients were reviewed retrospectively to identify candidates for migraine prophylactic therapy based on excessive triptan utilization. Use of a prophylactic agent was then characterized for these patients, and an educational mailing was sent to practitioners directly involved in the care of patients who did not appear to be using prophylaxis. Patient profiles were again assessed 6 months following the mailing to determine if a trial of a prophylactic drug had been attempted.

A total of 1909 patients were identified as having at least one claim for a triptan drug in the year studied. Of these patients, 360 appeared to be candidates for prophylaxis, but 154 had no record of prophylactic drug use. In the 6 months following the intervention mailing, 27 of the 91 non-prophylaxis patients (30%) who were still active clients of Idaho Medicaid and who had seen their physician during that time, appeared to have been given a trial of a migraine prophylactic drug.

Following an educational intervention for Idaho Medicaid patients identified through retrospective DUR, a trial of a migraine prophylactic drug was initiated for approximately one-third of potential candidates.