90.4%
of primary care physicians actively treating Medicare patients with migraine have never prescribed a CGRP medication
15,624
PCPs never prescribed a CGRP to a Medicare patient
17,284
active triptan-prescribing PCPs in this analysis
Published June 1, 2026 · Data: CMS Medicare Part D Prescriber Public Use Files
CC BY 4.0What we measured
We analyzed CMS Medicare Part D Prescriber Public Use Files — the only publicly available dataset that links individual physicians to specific medications at the national level. We identified 17,284 primary care physicians (Family Practice, Internal Medicine, and General Practice) who wrote 20 or more triptan prescriptions to Medicare patients in the observation period, indicating an active migraine patient panel.
Among those physicians, we found that 15,624 — 90.4% — had never written a single CGRP prescription to any Medicare patient. CGRP-targeting medications (monoclonal antibodies and gepants) have been FDA-approved for migraine prevention since 2018 and are recommended as first-line preventive therapy in current AHS guidelines.
Medicare scope note
This analysis reflects prescribing patterns for Medicare-insured patients only. Because migraine prevalence peaks in working-age adults who are predominantly commercially insured, and because commercial payer prior authorization requirements for CGRPs are often more stringent, the gap documented here is a conservative lower bound. The true national gap across all payers is likely larger.
Notable findings
Best state
73.3%
Kentucky
Worst state
97.6%
Minnesota
Madison, WI
100%
51 of 51 active prescribers
Fontana, CA
100%
45 of 45 active prescribers
All states
Showing 52 states
District of Columbia
100%
6 of 6 PCPs
Hawaii
100%
40 of 40 PCPs
Puerto Rico
100%
74 of 74 PCPs
Minnesota
97.6%
415 of 425 PCPs
Colorado
96.7%
238 of 246 PCPs
Nevada
96.1%
146 of 152 PCPs
Wisconsin
95.9%
424 of 442 PCPs
Massachusetts
95.8%
342 of 357 PCPs
Wyoming
95.7%
22 of 23 PCPs
Maine
95.5%
84 of 88 PCPs
Arizona
95.1%
369 of 388 PCPs
Oregon
95.1%
327 of 344 PCPs
Rhode Island
94.9%
75 of 79 PCPs
Montana
94.8%
73 of 77 PCPs
Washington
94.8%
367 of 387 PCPs
North Dakota
94.7%
36 of 38 PCPs
Iowa
94.5%
224 of 237 PCPs
New Mexico
94.4%
85 of 90 PCPs
South Dakota
94.4%
34 of 36 PCPs
California
93.2%
2,096 of 2,250 PCPs
Utah
93.1%
217 of 233 PCPs
Michigan
92.9%
533 of 574 PCPs
New Hampshire
92.9%
52 of 56 PCPs
Maryland
92.8%
116 of 125 PCPs
Illinois
91.8%
446 of 486 PCPs
Texas
91.8%
738 of 804 PCPs
West Virginia
91.8%
112 of 122 PCPs
Vermont
91.2%
31 of 34 PCPs
North Carolina
90.8%
521 of 574 PCPs
Ohio
90.4%
641 of 709 PCPs
Florida
90.3%
1,075 of 1,191 PCPs
South Carolina
90.1%
328 of 364 PCPs
Pennsylvania
89.9%
750 of 834 PCPs
Delaware
89.7%
35 of 39 PCPs
New Jersey
89.4%
177 of 198 PCPs
Connecticut
89%
113 of 127 PCPs
Oklahoma
88.1%
222 of 252 PCPs
Kansas
88%
147 of 167 PCPs
Idaho
87.1%
121 of 139 PCPs
Nebraska
87%
94 of 108 PCPs
New York
86.6%
700 of 808 PCPs
Virginia
86.6%
253 of 292 PCPs
Georgia
86.1%
415 of 482 PCPs
Indiana
85.7%
403 of 470 PCPs
Alabama
85.1%
366 of 430 PCPs
Missouri
84.6%
435 of 514 PCPs
Mississippi
84.4%
81 of 96 PCPs
Louisiana
84.2%
176 of 209 PCPs
Tennessee
84.1%
369 of 439 PCPs
Alaska
80%
4 of 5 PCPs
Arkansas
80%
224 of 280 PCPs
Kentucky
73.3%
252 of 344 PCPs
Why the gap exists
Prior authorization is the dominant structural barrier. CGRP-targeting therapies require prior authorization from the majority of commercial and Medicare Advantage insurers. The average PA takes 15–45 minutes of staff time per submission, with denial rates of 20–40% on first attempt. Primary care practices without dedicated PA staff face a straightforward calculation: the administrative cost of attempting a CGRP PA exceeds the time available.
This is not a knowledge gap. The PCPs in this analysis are actively prescribing triptans — they are engaged with migraine care and familiar with the treatment landscape. The gap is between what they know is available and what they can practically prescribe given the administrative environment.
About the data
- Data source
- CMS Medicare Part D Prescriber Public Use Files
- Data year
- 2022-2023
- Data scope
- Medicare patients only. Only publicly available provider-level prescribing dataset in the US
- Active prescriber definition
- Triptan_Claims ≥ 20 in the observation period
- CGRP-never definition
- CGRP_Claims == 0 in CMS observation period — absence in observation window, not lifetime never
- Specialty codes
- Family Practice, General Practice, Internal Medicine
- CMS suppression note
- CMS suppresses counts below 11 patients per drug — small number of CGRP prescribers may be undercounted, slightly inflating gap
- Published
- 2026-06-01
About The Headache Vault
The Headache Vault is a clinical platform that helps primary care physicians navigate prior authorization for CGRP and other headache medications. The PA Engine is free for all clinicians.
Try the PA Engine →Citation
Doty A. The 2026 Medicare Migraine Prescribing Gap Report. The Headache Vault; 2026. Available at: https://headachevault.com/research/prescribing-gap/ Licensed CC BY 4.0.