Don't fret about Lilly's 3rd-to-market start in CGRP, executive says.

Eli Lilly's Emgality didn't take the first-to-market crown in the budding CGRP field of migraine prevention drugs. It didn't even come in second. But a top executive believes Lilly has what it takes to make Emgality not only stand out from the crowd, but become the cornerstone of a migraine and pain franchise.

For one thing, the company has expertise in "consumer driven" fields like migraine, Lilly Bio-Medicines President Christi Shaw told FiercePharma, where patients tend to ask for a particular brand. And there are reasons they'd push for Emgality, she figures: The drug has strong numbers on efficacy and its injection device is better than its rivals, Amgen's Aimovig and Teva Pharmaceutical's Ajovy, Shaw said. "We believe we have the best autoinjector," she said.

The Emgality injector is the same as Trulicity's, now used by 1 million diabetes patients. Judging from the feedback from those patients, the injector is easy to use—a sentiment 90% of patients in Emgality's clinical trials agreed with, Lilly execs have said. As for efficacy, some patients on Emgality experienced complete freedom from migraines in clinical testing, Shaw said, and the drug's label lists some benefits its competitors' labels don't.

But Lilly has another obstacle to overcome with its launch, Shaw pointed out. Its rivals already had established neurology sales teams, while her company had to set up a team for the Emgality launch and others to come, including its acute migraine treatment lasmiditan later this year and, potentially, the Pfizer-partnered pain drug tanezumab. Reps who previously called on rheumatologists for osteoporosis drug Forteo were redirected to call on on neurologists and primary care doctors. Now, Shaw said Lilly has staff in place "to be able to launch all of these medicines very well."

Since its approval in late September, most payers have gotten on board with Emgality, Shaw said; only one small payer has outright rejected the drug. With other payers, Lilly has either secured coverage—as with Express Scripts—or believes negotiations bode well.

That wasn't what some investors had expected, either. Ahead of the launch, Shaw said some were worried that CGRP migraine prevention drugs would suffer a similar fate to PCSK9 cholesterol drugs, which launched back in 2015 to fanfare but quickly faltered because of payer restrictions. The treatments haven’t met early expectations, and Amgen recently announced a significant price cut to its PCSK9 offering, Repatha.

Despite those early worries, Shaw said she sees two major differences in the drug classes. For one, migraine is a consumer-driven market. Patients who suffer migraines will demand their treatment of choice because the episodes are so debilitating and dramatically affect their lives. Second, the drugs aren’t priced as high as PCSK9s. Each new CGRP drug carries a list price of $6,900 annually, compared with PCSK9 launch prices around $14,000 per year.

Lilly hasn't released early sales or market share figures for Emgality, but at a presentation Tuesday Amgen CEO Robert Bradway said 150,000 patients have already started on Aimovig. As Teva works to move past struggles in the generic industry, it hit a setback with its Ajovy launch when Express Scripts opted to prefer Amgen and Eli Lilly drugs over Ajovy.