Newer Neurologic Therapies Costly, Less Likely to Be Used

Study finds treatments given to less than 20% of people with 11 conditions

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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Fewer than 1 in 5 people living with multiple sclerosis (MS) or 10 other neurological conditions in the U.S. are on new-to-market medications.

That’s according to a large data study funded by the American Academy of Neurology, which also linked more recently available treatments — those approved in the U.S. between 2014 and 2018 — to higher costs, part of which comes directly from the pockets of a person with private health insurance.

“We are living in a time when new treatments bring hope to people with neurologic diseases and disorders,” Orly Avitzur, MD, president of the American Academy of Neurology, said in an academy press release. “However, even existing prescription medication can be expensive and drug prices continue to rise. In order for neurologists to provide people with the highest quality care, it is imperative that new drugs are accessible and affordable to the people who need them.”

The study, “Costs and Utilization of New-to-Market Neurologic Medications,” was published in the journal Neurology.

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Treatments for conditions ranging from migraine to MS and Parkinson’s

Over the past decade, a number of treatments were approved in the U.S. for neurological conditions. Many of these medications mean care advances for people who have few or no treatment options.

A team of researchers in the U.S. compared the cost of newer treatments and their use with existing medications for 11 conditions: neurodegenerative diseases such as MS, Parkinson’s disease, amyotrophic lateral sclerosis (ALS), Huntington’s disease, and neuromuscular conditions such as Duchenne muscular dystrophy, spinal muscular atrophy (SMA), and myasthenia gravis.

Other included conditions were migraine, orthostatic hypertension (a sudden increase in blood pressure that occurs when a person stands up), tardive dyskinesia (marked by repetitive movements of the jaw, lips, and tongue), and transthyretin amyloidosis.

Researchers looked at health insurance claims filed at any point from 2001 to 2019 to identify people with at least one of these conditions and a prescription for a new or existing disease-specific medication.

Of the more than 2.5 million people included in the study, 2.3 million had migraine, followed by 76,990 with MS, and 67,917 with Parkinson’s. The smallest group evaluated was SMA with 10 patients identified.

MS treatments approved by the U.S. Food and Drug Administration (FDA) between 2014 and 2018 included Ocrevus (ocrelizumab) and Plegridy (peginterferon beta-1a).

“We found that the utilization of most new-to-market medications was small,” less than 20% in all but one disease, “compared to existing, guideline-supported medications,” the researchers wrote, while “out-of-pocket and standardized total costs were substantially larger.”

Tardive dyskinesia was the lone use exception, with the proportion of patients prescribed a newer medication reaching 32%.

On average, the total cost of a 30-day supply was higher for newer than older medications.

While costs paid directly by patients were also larger, “the distribution of out-of-pocket costs were highly variable and the trends over time were unpredictable compared to existing guideline-supported medications,” the researchers wrote.

These findings highlight that “despite the increasing number of FDA-approved neurologic medications, utilization of newly approved medications in the privately insured population remains small,” they wrote.

“For new, high-cost medications that have similar effectiveness to older drugs, limited use is likely appropriate,” said Brian C. Callaghan, MD, the study’s senior author and a neurologist with the University of Michigan Health in Ann Arbor.

“However, future studies are needed to look into whether the high costs are barriers to those new medications that can really make a difference for people living with neurologic disease,” added Callaghan, also a fellow of the American Academy of Neurology.

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