An estimated 46,972 patients in District of Columbia are not receiving guideline-appropriate preventive migraine care from their primary care provider
How District of Columbia compares
District of Columbia's gap rate of 100% is consistent with the national pattern of 90.4%. Of the 6 primary care physicians in District of Columbia actively treating Medicare patients with migraine, 6 have never written a CGRP prescription. This is not a District of Columbia-specific failure — it is a national crisis that District of Columbia is experiencing alongside 47 other states.
What this means for patients
A patient with frequent migraine who sees their primary care physician in District of Columbia has a 100% chance that their doctor has never prescribed a CGRP-targeting therapy. This is not a reflection of physician knowledge or intent — it is the predictable consequence of prior authorization requirements that make CGRP prescribing administratively prohibitive in primary care.
About the data
Based on CMS Medicare Part D prescribing data — the only publicly available provider-level prescribing dataset in the United States. Active prescriber = 20+ triptan claims in the observation period. Medicare patients represent a subset of the total migraine population; the true gap is likely larger. Full methodology →
Getting CGRPs approved in District of Columbia
Prior authorization burden is the primary structural explanation for this gap. The Headache Vault PA Engine navigates District of Columbia payer requirements — covering all major commercial insurers and Medicare Advantage plans. Free for all clinicians, no account required.
Run a PA — free →District of Columbia Medical Society members: this data and tool are free to share with your members. All data on this page is CC BY 4.0.
Citation
Doty A. Migraine Prescribing Gap in District of Columbia. The Headache Vault; June 2026. Available at: https://headachevault.com/research/prescribing-gap/district-of-columbia/ Licensed CC BY 4.0. Data: CMS Medicare Part D Prescriber Public Use Files, 2022-2023.