Barriers to access to anti-CGRP monoclonal antibodies in Spain: survey of neurologists, hospital pharmacists, and patients

INTRODUCTION: Neurologists, hospital pharmacists (HP), and patients advocate for improved access to anti-CGRP monoclonal antibodies (mAbs) in migraine prophylaxis. OBJECTIVES: To identify the barriers to access to anti-CGRP mAbs in Spain and to propose potential solutions. MATERIAL AND METHODS: Cross-sectional study with online surveys aimed at neurologists, HPs, and patients. Descriptive statistics were used to analyse the data. Categorical variables were expressed in terms of frequency and percentage. RESULTS: A total of 55.1% of neurologists and 67.4% of HPs reported that at their hospitals, the criteria of the therapeutic positioning statement (TPS) were followed on a case-by-case basis to authorise the dispensing of anti-CGRP mAbs. However, more than 30% of neurologists and HPs reported that they had their own protocols. A total of 62.8% of neurologists and 23.3% of HPs disagreed with some TPS criteria and, according to 41.9% of pharmacists, not all neurologists at their hospital were able to prescribe anti-CGRP mAbs. Neurologists and HPs considered that the TPS criteria should be reviewed periodically. Some 32.9% of patients considered access to a migraine specialist to have been difficult. A total of 88.4% of neurologists and 81.4% of HPs thought that referral from primary care to a specialised consultation should be faster. CONCLUSIONS: The main barriers to accessing anti-CGRP mAbs are the difficulty of accessing a neurology specialist, and the strict TPS criteria and differences in their application between autonomous communities and hospitals. Neurology referral systems should be improved and TPS criteria reviewed.