47% Rise Seen in US Medicare Payments for MS and Like Therapies, 2013-17

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by Vanda Pinto PhD |

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Medicare Part D payments

The cost of medications for multiple sclerosis (MS) and other neurologic disorders saw a sharp rise between 2013 and 2017 in the U.S., a study of Medicare prescription claims shows. Analysis of Medicare payments during these five years revealed that the cost of neuroimmunology therapies, mostly for MS, increased by 47%.

This steady and potentially damaging rise in costs, its researchers added, was specific to brand-name treatments and not to generics.

The study, “Five-Year Trends in Payments for Neurologist-Prescribed Drugs in Medicare Part D,” was published in the journal Neurology.

“Previous research has shown that drugs prescribed for neurologic disease are the most expensive part of neurologic care for people on Medicare,” Adam de Havenon, MD, of the University of Utah, study author, said in a press release. “Our study shows a dramatic increase in the prices of neurologic medications over five years and the increase remained large even after being adjust[ed] for inflation.”

Researchers led by a University of Utah team analyzed payments for neurologist-prescribed medications, based on prescription claims in the Medicare Part D Prescriber Public Use Files from 2013–17. Medicare is a U.S. government insurance program for people ages 65 and older and those with certain disabilities and disorders; Part D covers prescription medications and refills, and notes their cost.

Claims data analyzed covered 520 medications for neurologic, or nervous system-related, conditions such as MS. Most of these medications were generic (322 out of 520), 137 were brand name even though a generic equivalent was available, and 61 were brand name without a generic equivalent.

To determine payment trends, “the percentage change in the per claim payment was compared between drug classes,” the researchers wrote.

Medicare paid $26.6 billion for the almost 91 million prescription claims made for neurologic medications from 2013 to 2017, the study reported.

The total number of claims for all nervous system-related medications rose by 7.6% over those years, while the total medication payments made by Medicare increased by 50.4%.

MS treatments were a majority of all neuroimmunology therapies requested during those years, which accounted for over 50% of total Medicare Part D payments for neurologic treatments, “despite being only 4.3% of claims,” the researchers wrote. Per claim, payments for these medications rose by 47%, from $3,337 to $4,902.

Prescription claims for brand-name therapies and generics were also analyzed, and adjusted for inflation. Payments for brand-name medications with a generic equivalent showed the highest increase (45%), followed by brand-name only medications (42.4%). Payments for generic therapy claims rose by 0.6% over the years studied.

Increases in generic (from 81.9% to 88%) and brand-name (from 4.9% to 6.2%) medication prescriptions were also evident, while prescription claims for brand-name medications that had a generic equivalent dropped significantly, from 13.3% to 5.8%.

“Our research shows generic medications are being prescribed more often, which can help reduce costs, but generic equivalents are not available for all brand name medications,” de Havenon said. “The rise in cost of some drugs must stabilize or be reversed.”

Researchers suggested that “unless the overall trend stabilizes or is reversed, or high cost-to-claim drugs are addressed, this trend will place an increasing burden on the neurologic Medicare budget,” they wrote.

“The most effective solution would be to find ways to control the price of drugs,” de Havenon said. “Neuroimmunology drugs for multiple sclerosis are the best place to start.”

This study was funded by the American Academy of Neurology (AAN), the world’s largest association of neurologists and neuroscience professionals.

“Most neurologic diseases and disorders are lifelong conditions and people with these disorders need medications to manage symptoms and reduce disability,”said  James C. Stevens, MD, AAN president. “The American Academy of Neurology is dedicated to promoting the highest quality patient-centered neurologic care and lowering drug prices is a top priority.

“The American Academy of Neurology is advocating for price controls on Capitol Hill including supporting Medicare drug pricing negotiation,” Stevens added.

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