Should MS Therapy Prices Reflect How Diligently We Take Our Meds?

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by Ed Tobias |

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Would you be more likely to stick to your MS drug schedule if being diligent lowered the cost of that drug? Biogen, which makes half a dozen MS drugs, including Avonex and Tysabri, seems to be betting that you would.

It’s no secret that patients have difficulty sticking to their drug routines. Back when I was using Avonex I developed needle fatigue. So I wound up cheating. I started injecting myself every eight or nine days, rather than every seven. Sometimes I even skipped a week. That, at least in theory, reduced the effectiveness of the treatment.

Now Prime Therapeutics,  a national pharmacy benefit manager (PBM), has announced a deal with Biogen that’s aimed at reducing the number of slackers. PBMs are the middlemen between your private insurance company, or Medicare, and your pharmacy. They negotiate drug prices, and/or rebates, with drug manufacturers and they create drug formularies, the list of drugs for which the insurance companies will pay.  (You can read a more detailed description this process in this Newsweek article).

Here’s the deal

The Prime Therapeutics deal with Biogen is called an “outcomes-based contract.” Though Prime’s news release is short on specifics, Prime’s chief medical officer, Dr. Jonathan Gavras, describes the agreement this way:

“With increasing use of specialty medications for complicated diseases, it’s extremely important to make sure members are staying on track with their drug therapy regimen. Using outcomes data under the pharmacy and medical benefits, Prime can structure these types of drug-specific contracts to help align price to clinical value for our clients and improve health outcomes for members.” (My emphasis).

Translating that into people-speak, I think that final sentence should say: “Take your drug the way you’re supposed to take it. That will improve your health. In return, we’ll keep our thumb on the price that you pay for it.”

I’m no expert about PBMs or the deals they make with drug makers. But the website BioPharmaDive, where I first read about all this, does a pretty good job of trying to explain what the Biogen/Prime deal is all about. “Insurers don’t want to pay for preventable risks when patients don’t take a drug,” it writes, “while drugmakers lose out on revenue if patients fall off treatment.”

There’s also a study

A few days before the Biogen/Prime deal was announced, a study was published reporting that MS patients who adhere to their treatments have better outcomes than those who slack off — but they also have higher healthcare costs. The timing may be just a coincidence, but the study, published in the The Journal of the American Osteopathic Association, was funded by Biogen.

More deals like this?

This isn’t the first outcome-based contract with an MS drug manufacturer. Prime Therapeutics cut a similar deal with EMD Serono back in 2012 for Rebif.

I’m willing to bet that we’ll see more of these outcome-based contracts in the future.

Are these contracts a three-way win, with patients, insurers and drugmakers all benefiting? What do you think?

(You’re invited to follow my personal blog at


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.




It's a win-win for the pharmaceutical and
insurance companies that reinforces steady and more reliable revenues; it's a win for doctor-patient relations; it's an insurer to envigorate normalizing doses and the acquisition of statistics and research; it's a 'Sword of 'Damocles' potential price increase excuse (another excuse) to potentially jack prices and continue to extort patients, always the fault of patients when the entire demographic is penalized, even the responsible ones. The real heroes are the compassionate charitable non-profits that assist by incurring patient costs. If not for them, we'd be financially and therapeutically depleted, and I, for example, would at the very least be quadraplegic by now. Why don't you call a spade a spade, and honor the unsung charitable heroes who deter us from being indigent? Pharmaceutical and insurance companies are in the money business, not the people business. Let's keep it real.


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