No Small Feat: Nurtec ODT

Jim Kramer, host of CNBC’s Mad Money, who also serves as the chief spokesman for the American Migraine Foundation, hosted Biohaven Pharmaceuticals CEO Vlad Coric, MD, as a guest in the beginning of June 2021. Much like the 97% of all migraine sufferers, he knows exactly what triggers a potential attack for him: “So Vlad, I wake up…immediately look at the weather. And the weather says there’s going to be a thunderstorm in seven hours, so I know I have to take a Nurtec because I’ll get a migraine if I don’t because that’s what happens with a barometric change.”

This interview aired a few weeks after Biohaven’s Nurtec ODT (orally dissolving tablet) added a new FDA approval for preventing episodic migraines after a pivotal Phase III trial. This new approval makes Nurtec the first oral CGRP (calcitonin gene-related peptide) receptor antagonist approved for preventive treatment of migraine and the only migraine medication approved for both acute and preventive treatment—a differentiator in the current market.

The new approval comes on the heels of an incredible quarter. From the beginning of April to the end of June, Nurtec’s total sales were $93 million, vastly exceeding Wall Street analysts’ projection of $50 million. Biohaven is a small, yet nimble company of about 1,000 employees advancing a digital-first, patient-centric approach with a CEO who believes “if you’re going to be smaller in size, you’ve got to invest in really good people. It’s people that make your corporation, not the other way around.”

Coric told Pharm Exec that they put a lot of care into growing a managed market team that was seasoned and high-performing. The team was assembled far in advance to create a budget impact analysis to approach insurance payers with the cost-effective benefits of getting migraine sufferers back to work and off disability. While a lot of drugs fail to hit the 60% insurance coverage mark, Biohaven hit 80% coverage in the first half of 2020, and subsequently hit 90% at the year mark. In contrast to Biohaven’s biblical “David” stature, AbbVie, which offers Nurtec’s main competitor Ubrelvy, is a Goliath company that boasts 40,000 strong. AbbVie introduced Ubrelvy (another orally administered CGRP receptor antagonist) a couple months before Nurtec in January 2020.

On Aug. 6 of this year, Biohaven reported that Nurtec ODT had a sizable advantage over Ubrelvy when it comes to new-to-brand prescriptions (new patients who’ve never been on a branded medicine), capturing 56% of the market share in comparison to Ubrelvy’s 44.1%. Despite being a highly efficacious treatment to stop a migraine at the onset, Nurtec ODT’s indication to prevent episodic migraine (fewer than 15 days of headaches per month) gives it an advantage far beyond the lean approach of only having to advertise one product for a dual therapy.

The World Health Organization characterizes migraine as one of the 10 most disabling medical illnesses in the world. With 40 million people in the US and 1 billion people worldwide suffering from migraine, it has the potential to fulfill a sizable unmet need—only 15% of people who meet the clinical criteria for preventive treatment actually use it. Generally, people take injectables for preventive, so the opportunity for a safe, effective oral solution is very apparent.

“We are now the only migraine medicine with one drug that has acute and prevention. So people can take it, treat their episode now, and prevent the next migraine. That’s a big deal,” says Coric. “In the past, migraine patients were put on multiple meds—triptans for acute and then Topamax for prevention. I believe it’s better to have less medicine in a person, so not only is it one dissolving tablet for acute and prevention, but you also don’t even need to take it every day to have the preventive effects.”

This flexibility allows patients and doctors to customize by dialing up or down between acute and preventive treatment. If you’re like “Ellie,” a student patient advocate that enrolled in a Nurtec clinical trial back in 2018, you might take Nurtec in anticipation of a big exam, an important function, or any other of the many migraine triggers.

Biohaven’s patient-centric approach is something its CEO is not only proud of but directly attributes to its commercial success. “As a physician, I wanted to develop the drug around patients, listen to what they’re telling us about how they want to use it, and then have the patient tell their story,” Coric told Pharm Exec. “So, what you’ll see in our marketing this last year is it’s not just Ellie but it’s all these social influencers and people who are willing to step forward, break down stigma after illness, talk about their illness and their response. That’s how we’re going to educate people.”

One of those social influencers is Khloe Kardashian, a mega-influencer with 174 million Instagram followers, who signed on in July of 2020. While it’s acknowledged that Kardashian’s reach is a wonderful benefit, Coric states that their partnership happened organically. After being clued in that she documented her struggle with migraine on Keeping Up with the Kardashians, he decided to reach out.

“We let Khloe know that there was a new treatment available, so she ended up trying it before we had any agreement,” says Coric. “She had a robust response and was so grateful. It doesn’t get any better than that—a genuine patient need, whether it’s Khloe or Ellie. Khloe had been suffering from migraine since she was a young adolescent, and [Nurtec] impacted her so much that she agreed to be a spokesperson.”

From there, Kardashian shared her experience on The View, and another migraine sufferer gave it a try and joined the ranks, Whoopi Goldberg, who had been suffering for 40 years. And if you’re a NASCAR fan, you’ll see Nurtec advertising on the 51 car of Rick Ware’s racing team throughout 2021. Ware’s son Cody has been suffering from stress-induced migraine since he was 18 years old, so for him, the conversion from hopeful patient to evangelist was similar. Coric summed it up to Pharm Exec, “It’s the patient story. We’re dedicated to following the patient’s story and telling it in a genuine way. That’s what we’re about.”

Despite fierce competition from players with much larger footprints, Biohaven looks to become the market leader in the oral CGRP space. Coric plans to stick to its small company roots, staying smart, nimble, and applying its digital-first, patient-centric strategy to other neuroscience solutions, much like it did when it launched Nurtec a couple weeks after the arrival of COVID-19 in the US.

Read the profiles of all 2021 product launch selections here.

Fran Pollaro is a Senior Editor for Pharm Exec. He can be reached at
fpollaro@mjhlifesciences.com.