Out-of-Pocket Costs of MS Treatments in US Soared from 2004-16, Study Finds

Out-of-pocket costs for medications treating neurological diseases have skyrocketed over the last 12 years in the U.S., with multiple sclerosis (MS) patients, especially, paying 20 times more in 2016 than they were in 2004, a study reported.

“Given the high costs of many neurologic medications and the increasing cost sharing by patients, the total cost burden carried by patients is likely increasing,” its researchers wrote, noting a 2017 study that found MS patients considered out-of-pocket costs “more important to them than drug efficacy and side effects.”

The findings were published in the journal Neurology, the medical journal of the American Academy of Neurology (AAN), in the article,“Out-of-pocket costs are on the rise for commonly prescribed neurologic medications.” It was funded by the AAN.

High medication prices can pose a heavy burden to patients, creating debt, forcing them to skip other essentials, or preventing them from taking their medications as frequently as needed.

Researchers at Michigan and Emory universities looked at changes in medication costs to patients over 12 years, from 2004 to 2016.

Using a large, private healthcare claims database, they analyzed out-of-pocket expenses paid by more than 912,000 people with five common neurologic diseases: MS, peripheral neuropathy, epilepsy, dementia, and Parkinson’s. 

They examined the five most-prescribed medications for each disease and a few other high-cost medications, and also compared costs for those in high-deductible health plans to those in traditional plans.

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MS medications examined were teriflunomide (Aubagio, marketed by Sanofi Genzyme), peginterferon-beta-1a (Plegridy by Biogen), interferon-beta-1b (Extavia by Novartis, and Betaseron by Bayer Healthcare), interferon-beta-1a (Rebif by EMD Serono, and Avonex by Biogen), glatiramer acetate (Copaxone by Teva Pharmaceuticals), fingolimod (Gilenya by Novartis), and dimethyl fumarate (Tecfidera by Biogen).

Out-of-pocket prices for MS therapies were seen to have the sharpest increase in those 12 years, rising from a mean monthly cost of $15 in 2004 to $309 a month in 2016, a 20-fold increase.

Direct costs to patients with other neurological conditions also rose for brand-name medications, although not as steeply.

MS patients whose health plans carried high deductibles also paid more than twice those in traditional plans in 2016, or an average of $661 per month compared to $246 a month.

“Patients in high-deductible health plans are particularly vulnerable to high out-of-pocket costs, given that their costs are usually twice as high as those of patients in traditional plans,” the researchers wrote.

Costs also varied widely both across and within neurological conditions. For instance, during the first two years after diagnosis, 5 percent of the MS patients at one end paid a total of $90, while 5 percent at the other paid $9,855 or more.

Equally troubling, out-of-pocket costs from 2014 to 2016 “have started to represent a larger proportion of the total costs,” the study said. “Given new high-priced neurologic medications coming to the market and the rise in high-deductible health plans, it is likely that out-of-pocket costs will continue to increase and become even more important to neurologists and patients.”

The study recommended as possible solutions, particularly for  MS patients, efforts to encourage the development of biosimilars and a better system of “negotiating drug prices,” one in line with that used by Veterans Affairs and he national health systems of other countries.

“With many new, high-priced neurologic drugs coming to market and a recent rise in use of high-deductible insurance plans, which shift costs to patients, it is likely out-of-pocket costs will continue to increase,” Brian C. Callaghan, MD, MS, with the University of Michigan and the study’s lead author, said in a press release.

“Out-of-pocket costs have risen to the point where neurologists should be able to consider the potential financial burden for the patient when prescribing medication, but they do not have this information available to them,” Callaghan added.