Overall Cost of DMTs Stable 2018–2020, Study Finds
The overall cost of disease-modifying therapies for multiple sclerosis (MS) in the U.S. remained stable from 2018 to 2020, according to pharmacy and medical claims data from Prime Therapeutics’ insured members.
Generics are nearly identical versions of an original branded medication, typically sold at lower prices.
The findings will be presented through a poster, “Multiple Sclerosis Disease Modifying Drugs: Expenditure, Utilization and New Start Trends among 15 Million Commercially Insured Members,” at the Academy of Managed Care Pharmacy Virtual Annual Meeting, which begins Monday and runs through April 16.
A national pharmacy benefit manager, Prime analyzes real-world medication use pattern changes to negotiate treatment prices and/or rebates with therapy manufacturers and to create lists of medications that health insurance companies, such as those in the Blue Cross Blue Shield Association, will pay.
“Prime analytics help identify the safest, most effective use of therapies and provide clients with insights they need to forecast cost trends and make data-driven business decisions,” Sarah Taylor, Prime’s vice president and chief analytics officer, said in a press release.
Catherine Starner, Prime’s senior principal health outcomes consultant, added that “real-world data helps Blue Plans ensure members start and continue on the right path with a treatment that is most appropriate for them and is a good value.”
A 2018 analysis conducted by Prime showed that members with MS had 8.3 times higher annual total healthcare expense than members without the disease. Notably, disease-modifying therapies (DMTs) — with a list price of about $80,000 a year for most of them — explained more than 80% of this cost excess.
This makes MS the fourth most expensive condition among Prime’s commercially insured members, following only autoimmune diseases, cancer, and HIV.
Since the latest MS treatment guidelines recommending the use of specific DMTs — such as Lemtrada (alemtuzumab), Gilenya (fingolimod), or Tysabri (natalizumab) — for highly active MS in 2018, several DMTs and generics have been approved in the U.S. However, few studies have since described changes in DMTs spending and use, as well as initial DMT selection.
“Payers need to understand real-world MS [DMT] utilization pattern changes in order to design optimal formularies and develop care management programs,” Prime wrote in the poster.
To this end, Prime analyzed integrated pharmacy and medical claims data from its 15 million commercially insured members from July 2018 through June 2020 to assess trends in cost, use, and new start rates of DMTs used for highly active MS.
Results showed that the monthly costs with MS DMTs per member remained relatively stable throughout the two-year study period.
While there was a drop in Teva Pharmaceuticals’ Copaxone pharmacy costs, likely due to the current availability of two lower-cost generics, this was offset by an increase in Genentech’s Ocrevus costs, or use, in the medical setting.
In fact, the costs for Ocrevus — the only approved therapy for primary progressive MS, in addition to relapsing forms of MS — showed the greatest growth for a single therapy, accounting for 16.9% of all DMT costs.
Moreover, since the 2018 guidelines there was a minimal increase in the proportion of highly-effective DMTs among MS patients initiating DMTs. In 2019, Ocrevus, Tecfidera (dimethyl fumarate), and Copaxone-related products were the most used DMTs as first treatment.
“Directing treatment-naive patients to generic and lower cost therapies represents a cost-saving opportunity for payers,” Prime wrote in the poster.
These findings also highlighted that for a complete understanding of MS DMT trends, “it is essential for insurers to integrate their pharmacy and medical claims data,” Prime wrote in the poster.
“Prime’s study of integrated claims and real-world use patterns of DMDs offers knowledge Blue Plans can use to develop care programs for members and help ensure appropriate and cost-effective specialty therapies are used,” the company stated in the release.