Alvaro San-Juan-Rodriguez, PharmDAlvaro San-Juan-Rodriguez, PharmD
A recent study suggests that the price of disease-modifying therapies (DMTs) for multiple sclerosis (MS) patients has persistently risen over a 10-year period, with the introduction of additional therapies failing to contain out-of-control costs.¹

The development of various DMTs since the initial introduction of interferon beta-1b in 1993 has been significant for MS patients hoping to manage the condition. However, healthcare providers seeking to understand their clinical application must consider the distorting influence of financial burden. Research suggests that clinical and financial considerations have already blurred, given out-of-pocket costs rank higher in priority for patient decision-making around DMTs than efficacy or safety.²

The recent study, published in JAMA Neurology, used Medicare Part D claims data to conclude that annual costs associated with self-administered DMTs for MS increased dramatically from 2006 to 2016, from a mean of $18,660 to $75,847. This represents a mean increase rate of 12.8% yearly, resulting in a roughly 7-fold increase in patient out-of-pocket costs.

The study authors also cited several earlier studies indicating that the cost of DMTs for MS has risen disproportionately compared with specialty medications prescribed to treat other illnesses. Neurologists must thus consider MS a special case in terms of cost-burden, even in the context of high general healthcare costs.

In an editorial, Daniel M. Hartung, PharmD, MPH, and Dennis Bourdette, MD, noted that Medicare is “spending more than 3 times as much for DMTs for this single illness as they pay to neurologists for all of the services that they provide.”³

Counter to conventional wisdom, the introduction of new therapies seems to have done nothing to abate the consistent surge in out-of-pocket costs for DMTs. While one might expect increased competition to drive down pricing, the study authors point out that “although Teva launched the branded glatiramer, 40-mg, at a similar price as the branded 20-mg version in 2014, the price of the 20-mg branded formulation increased substantially the following year. This could have represented an attempt to encourage the use of the 40-mg formulation in anticipation of the entry of a generic version for the 20-mg formulation.”

Given the across-the-board nature of these price increases, reducing their cause to individual corporate decisions won’t elucidate the complexity of the problem. Looking at broad market trends and a regulatory environment that compels economic actors toward certain decisions is key.

The authors of the editorial noted that several states are considering legislation to address runaway prices for MS treatment. The Trump administration has also proposed changes to the Medicare Part D reimbursement process, which may help patients with high out-of-pocket expenses. The authors ultimately suggest that, individually and as members of national associations, neurologists should leverage their relationships with pharmaceutical and biotechnology companies, but it is clear there is a long and uncertain road ahead to address what has become a challenging issue for both patients and the healthcare industry.
REFERENCES
1. San-Juan-Rodriguez A, Good CB, Heyman RA, Parekh N, Shrank WH, Hernandez I. Trends in prices, market share, and spending on self-administered disease-modifying therapies for multiple sclerosis in Medicare Part D. JAMA Neurol. Published online August 26, 2019. doi:10.1001/jamaneurol.2019.2711.
2. Hincapie AL, Penm J, Burns CF. Factors associated with patient preferences for disease-modifying therapies in multiple sclerosis. J Manag Care Spec Pharm. 2017;23(8): 822-830.
3. Hartung DM, Bourdette D. Addressing the rising prices of disease-modifying therapies for multiple sclerosis. JAMA Neurol. Published online August 26, 2019. doi:10.1001/jamaneurol.2019.2445.