The National Health Care Institute has advised the Minister of Health, Welfare and Sport (VWS) to extend the reimbursement conditions for 3 subcutaneous CGRP inhibitors. These are the medicines erenumab (Aimovig®), fremanezumab (Ajovy®) and galcanezumab (Emgality®). Subcutaneous means that these medicinal products are injected under the skin. These medicines can help certain patients with regularly recurrent migraine to have less frequent migraine attacks. These products are already registered in the Medicines Reimbursement System (GVS). If we give positive advice and the Minister adopts this, the conditions for reimbursement will be expanded. We do recommend additional conditions for reimbursement.
Download in English: GVS advice on CGRP inhibitors erenumab (Aimovig®), galcanezumab (Emgality®) and fremanezumab (Ajovy®) for migraine
Download: Additional GVS advice on subcutaneous CGRP inhibitors
Current state of affairs: advisory report sent to the Minister
The National Health Care Institute has sent this advice to the Minister of VWS. The Minister makes the final decision whether or not to reimburse the medicinal product from the basic healthcare package.
Update June 2025: The National Health Care Institute advises expansion of List 2 conditions
In an additional advisory report, the National Health Care Institute advises the Minister of Health, Welfare and VWS to expand the List 2 conditions for erenumab, fremanezumab and galcanezumab. The National Health Care Institute was unable to do so in the March 2025 advisory report because discussions were still taking place on this subject with the parties in the field.
Erenumab, fremanezumab and galcanezumab intended for certain people with migraine
Erenumab, fremanezumab and galcanezumab are the active substances. The brand names are respectively Aimovig®, Ajovy® and Emgality®. The medicines are administered by injection under the skin.
The medicines can be used for people with migraine. During a migraine attack, something happens in the nervous system, causing the blood vessels in the head to narrow first and then expand strongly. That expansion of the blood vessels causes the headache. Migraine attacks last between 4 and 72 hours and inhibit daily activities. There are 2 forms of migraine, namely regularly recurrent (episodic) and chronic migraine. The severity of the symptoms is the same. People with episodic migraine have headaches for more than 4 and less than 14 days per month. People with chronic migraine have headaches more than 14 days each month.
The National Health Care Institute advice on the reimbursement of erenumab, fremanezumab and galcanezumab
The National Health Care Institute advises the Minister of VWS to reimburse erenumab (Aimovig®), fremanezumab (Ajovy®) and galcanezumab (Emgality®) from the basic healthcare package for people with episodic migraine. For this to happen, the marketing authorisation holders will have to reduce their prices by at least 25%. It is still difficult to estimate how many people with episodic migraine are eligible for these medicinal products if they are reimbursed. For this reason, the National Health Care Institute also advises negotiating with the marketing authorisation holders about volume-related price reductions of 25% or more. That means that if the number of medicinal products that is sold increases by large quantities, the marketing authorisation holder will give a discount. Only then is it socially responsible to also reimburse CGRP inhibitors for people with regularly recurrent migraine.
For more information on the GVS and the Lists 1A, 1B and 2, see page ‘Reimbursement of outpatient medicines’.
Conditions for reimbursement of erenumab, fremanezumab and galcanezumab
Conditions set out in the advisory report of 12 March 2025
Erenumab, fremanezumab, galcanezumab have an added value compared to placebo as prophylaxis of episodic migraine (EM) in adults with at least 4 migraine days per month as the last treatment option after failure on treatment with the 5 categories of migraine prophylactics listed in the current guideline: angiotensin receptor blocker (candesartan), beta-blockers (metoprolol or propranolol), anti-epileptics (topiramate or valproate), calcium receptor antagonists (flunarizine), and tricyclic antidepressants (amitriptyline), regardless of the order.
Conditions set out in the advisory report of 26 June 2025
Only for an insured person with episodic migraine with at least 4 migraine days per month following failure of prophylactic treatment with the following 5 categories of migraine prophylactics (regardless of sequence):
- angiotensin receptor blocker, and
- β-blocker, and
- tricyclic antidepressant, and
- topiramate or valproate, and
- calcium receptor antagonist.
Only for an insured person with chronic migraine after exclusion or treatment of medication overuse headache and after failure of prophylactic treatment with (regardless of sequence):
- topiramate or valproate, and
- at least 2 attempts with botulin toxin A (6 months) according to the PREEMPT protocol, unless it is an insured person with chronic migraine who had already been treated with a CGRP inhibitor under a managed access programme prior to 17 September 2021.
In addition, the following applies for both episodic migraine and chronic migraine:
- All treatment steps should be performed in adequate doses with a minimum treatment duration in accordance with the current treatment guidelines before starting a CGRP-mAb.
- Treatment steps can only be skipped in case of contraindications and can be discontinued prematurely in case of adverse effects.
- An insured person with at least 4 migraine days per month who has previously been treated with a CGRP-mAbs for migraine does not need to go through the above treatment steps again.
- Both the indication, treatment and prescription of CGRP-mAbs is reserved for (or falls under the responsibility of) a neurologist.
More information or questions?
If you have any questions about this advice, please send your question to the National Health Care Institute via warcg@zinl.nl. If you have questions about the reimbursement of a medicinal product, the personal expenses or whether you should pay a contribution, please ask your health insurance provider.
How did the advice come about?
The Scientific Advisory Board (WAR) and the Insured Package Advisory Committee (ACP) advise the National Health Care Institute during the assessment. [Or if WAR and ACP are not involved: The Minister of Health, Welfare and Sport asks the National Health Care Institute to make an assessment.] The Minister makes the final decision whether or not to reimburse the medicinal product from the basic healthcare package.
Explanation about the reimbursement of medicinal products
Erenumab (Aimovig®), fremanezumab (Ajovy®) and galcanezumab (Emgality®) are extramural medicines. Extramural means: medicines for home use that can be obtained at the pharmacy with the prescription from a physician. They are only reimbursed from the basic healthcare package if they are listed in the GVS.