Specialty Pharmaceuticals Mean Specialty Prices

Ed Tobias avatar

by Ed Tobias |

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If you have MS, you’ve probably used a specialty drug. My first was Avonex, which I began to use about 1998. Several others followed.
There’s no formal definition of a specialty drug, but these therapies have several things in common. First, they’re expensive. According to the vice president in charge of specialty drugs at CVS Pharmacy, the average monthly cost is $3,000. A CVS website article says that’s about 10 times the cost of a non-specialty medication. Many specialty drugs are hard to administer, requiring an injection or infusion. And it may require special handling. My Avonex, for example, had to be shipped with dry ice to keep it cool.
So, I’m not surprised that the cost of specialty drugs is so much higher than your average prescription med. What really does bother me, however, is how fast the cost of these specialty drugs has been climbing.

Let’s look at the numbers

A few weeks ago, AARP released a lengthy report that studied 101 specialty drugs. Here are the headlines:
  • The price of the most widely used specialty prescription drugs increased substantially more than the general inflation rate in every year from 2006 to 2015.
  • From 2014 to 2015, specialty drugs had their highest annual price increase in a decade: an average hike of 9.6 percent. Inflation, on the other hand, increased by only 0.1 percent.
  • Prices for 29 chronic-use specialty drugs that have been on the market since the beginning of the study (from January 2006 to December 2015) increased cumulatively by an average of 177.3 percent. In contrast, general inflation increased by only 19.4 percent during the same period.

MS drugs are best-sellers

Multiple sclerosis drugs made up 12 of the 101 specialty drugs studied. Their average price rose 10.8 percent between 2015 and 2016, a little higher than the group average. Seven of those dozen MS drugs made the study’s list of 30 best-selling specialty drugs. (You can see the full list on page 30 of the report.)


6 Copaxone 20mg $201 7.6
7 Tecfidera 240mg $194 10.8
11 Copaxone 40mg $179 7.0
16 Avonex Auto-inject $198 15.2
17 Avonex Pre-filled $200 16.2
21 Rebif 44mcg $207 10.8
27 Betaseron 0.3mg $202 11.1

The drug that jumps out at me from this list is Avonex. Why should the price of a drug that’s been in use for nearly 20 years jump 15-16 percent in a year? Copaxone and Tecfidera both lead Avonex in sales, yet their price hikes were lower. Color me confused.

What’s the solution?

Is there a way to limit these price increases? In the CVS article I mentioned earlier, Dr. Alan Lotvin makes several suggestions, most of which don’t work for me.

Lotvin: “… Prior authorization and step therapy can be highly effective in controlling costs.”

Me: Step therapy means reducing costs by prescribing older, possibly less-effective drugs first rather than aggressively attacking MS with newer, more potent drugs. Some insurance companies insist patients follow this path, but it’s not the way that I want my MS treated.

Lotvin: “Another approach is the use of tiered formularies that require higher patient cost-sharing for more expensive therapies.”

Me: Yes, they do. And this is why many MS patients can’t afford to pay for the therapy that could be the most effective for them (though there are drug company programs that help some patients pay for these drugs).

Lotvin: “Ensuring that the drugs are administered at the lowest-cost site of care is also important — in most instances the hospital outpatient center is the highest-cost site of drug administration, while patients’ homes and doctors’ offices are typically the lowest.”

Me: Here, we agree.

The AARP study concludes:

“If recent trends in specialty drug prices and related price increases continue, it will almost undoubtedly become more difficult for patients to access and afford necessary specialty medications. The pricing patterns (price levels and price increases) for specialty drugs will lead to serious problems with respect to access and affordability issues in the future.”

Since access and affordability are already a problem, it seems to me that the future is now.

Yet, AARP offers no solutions, ending its report this way:

“Policy makers interested in reducing the impact of prescription drug prices should focus on options that drive significant innovation while also protecting the health and financial security of consumers and taxpayer-funded programs like Medicare and Medicaid.”

Well, yeah. But how do we find those options? The FDA has now approved generics for Copaxone 20mg and 40mg. That’s not an innovation, but, hopefully, it will help stick a pin in at least one specialty price balloon.

You’re invited to visit my personal blog at www.themswire.com.


Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.


Patty Long avatar

Patty Long

Soecialty Drugs are often Bilogics which need extra care & precautions to produce. Plus, as stated, a lot of them need special packaging & shipping. What I want to know is: Why is the No Compete Clause still in the Medicare By Laws and Why aren't prescriptions automatically included. My husband, fortunately, has a great benefit package at work. He pays our share in premiums. The Drug Companies have Co-Pay Assist programs for people like me that translates to $0 coming out of my pocket. They're not legally allowed to offer this to people on Medicare!

Ed Tobias avatar

Ed Tobias

Hi Patty,

Thanks for your comments. I also ran into this problem. When I was on commercial insurance I was receiving co-pay assistance for Ampyra and Aubagio. After I retired, and my retirement plan required that I go to Medicare as my primary insurance, the co-pays ended. I had to drop Ampyra and switch from Aubagio (covered under Part-D with a high co-pay) to an infusion (covered fully under Part-B + my secondary).

As things are going now it's only going to get worse, not better.


Irini Pateraki avatar

Irini Pateraki

In my opinion, this is an indirect way where the state finances directly the pharmaceuticals. I am a research at a university and I could describe several others. If the state would like, I am sure it could somehow control these prices. I am on tecfidera and I known it's an old drug, used for years for another autoimmune disease, psoriasis. The company selling it today just changed the dosage and did few clinical trials. How they can explain these prices? The minimum has been spent in research for this specific drug, which is of course very efficient by the way...

dave kirchner avatar

dave kirchner

It is obvious the AARP has learned to babble sounding intelligent and say nothing. Must be same speech school house and senate members graduate from. Medicare in some states will not pay at all for MS drugs because 'they do not cure' the disease.

Ed Tobias avatar

Ed Tobias

Hi Dave,

Thanks for your comments.

Can you tell me in which states Medicare won't pay for MS drugs because "they do not cure the disease?" As far as I know Medicare rules the same across all states. Are you sure it's Medicare or, possibly, are you talking about Medicaid? And, if it's Medicaid, I'd still like to know the states so that I can look into this. I find it difficult to believe that "not a cure" is being used as a reason for denial of coverage.



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