Cost of treatment

Treatment of secondary progressive multiple sclerosis (SPMS) patients with the investigational oral therapy Mayzent (siponimod) significantly reduced the risk of disability progression and decreased inflammation, compared to best supportive care, according to a preliminary draft evidence report from the Institute for Clinical and Economic Review (ICER). The report…

Are you having trouble paying for MS medications? If so, you’re not alone. People change or lose their insurance, and plans change the medications they cover from year to year. Your neurologist may change your medication without realizing that moving you from an injection to an oral med may…

Medical Marijuana ‘Can Help Everyone,’ Says Director at Maryland Cannabis Facility Keeping in mind that the person quoted in this article, Mr. Castleman, is growing medical marijuana to make money, I wouldn’t expect him to say anything else. On the other hand, I firmly believe that some forms of…

This probably won’t come as a surprise to you if you’re on Medicare: It’s getting harder to obtain approval for many of the disease-modifying therapies (DMTs) prescribed for people with multiple sclerosis (MS). I see complaints about this all the time on social media. Now, research reported in…

Restrictive access policies by Medicare and a rising cost-sharing burden lead to an increased price of disease-modifying therapies for multiple sclerosis patients, according to new research. The findings also revealed that Medicare beneficiaries without a low-income subsidy may spend on average $6,894 for their MS treatments in 2019, with generic versions of Copaxone representing the highest burden. Approximately 25-30% of patients with MS are covered by Medicare through disability. In 2013, MS Medicare beneficiaries with MS and without low-income subsidies averaged $4,389 a year in out-of-pocket expenses, second only to hepatitis. Despite a greater number and diversity of DMTs for MS treatment, their price has increased substantially over the past two decades. In fact, expenses related to DMTs for MS are among the highest by class in the Medicare market. “It’s a dysfunctional market that lacks the typical incentives for most other consumer prices,” Daniel Hartung, the study’s lead author, said in an Oregon Health & Science University (OHSU) press release written by Erik Robinson. “Aside from the public optics, there are few incentives for companies not to raise prices. Most intermediaries in the drug distribution channel, including drug companies, benefit from higher prices,” Hartung said. These high prices may lead to reduced access, as insurance companies can restrict coverage or manage use through prior authorization or step-therapy policies, and high deductibles or cost-sharing components in health plans that increase the financial burden for patients. Now, a team at OHSU and the Oregon State University College of Pharmacy used prescription drug plan formulary files to analyze changes in coverage policies from 2007 to 2016, and to estimate out-of-pocket spending for DMTs for MS within Medicare Part D program, through which outpatient prescriptions are financed. Eleven DMTs available during the study period were analyzed. Tysabri and Lemtrada were not part of the analysis because they are delivered via intravenous infusion in the clinic setting, and are typically covered through Medicare Part B. Results revealed that the price for Betaseron , Copaxone 20 mg , Rebif, and Avonex — the four therapies available in 2007 — quadrupled over the 10-year study period. Except for Copaxone 40 mg and its 20 mg generic formulation (Glatopa, by Sandoz), prices for the other DMTs introduced after 2007 increased by 9–13% per year. These include Novartis’ Extavia (interferon beta-1b) and Gilenya (fingolimod), Biogen’s Plegridy (peginterferon beta-1a) and Tecfidera (dimethyl fumarate), and Sanofi Genzyme’s Aubagio (teriflunomide). In 2007, 99-100% of plans covered the four available medications, with the exceptions being Rebif (88%). These percentages fell to 54-89% in 2016. Coverage of the other DMTs varied between 21% (Extavia) to 92% for Copaxone 40 mg. In turn, coverage for the three oral options — Gilenya, Aubagio and Tecfidera — generally increased or was maintained over time, ranging from 46% for Aubagio to 83% for Gilenya. The use of prior authorization increased from 61-66% in 2007, to 84-90% in 2016. Also, the share of plans with at least one DMT available without limitations declined from 39% to 17%. The average projected out-of-pocket spending for 2019 across DMTs was $6,894. The highest projected out-of-pocket expenses ($8,219) are associated with generic glatiramer acetate, both Glatopa and Mylan’s 20 mg/mL and 40 mg/mL generic formulations, approved by the U.S. Food and Drug Administration in 2017. This is more than with any of Copaxone’s formulations. According to the team, this is the result of a higher coinsurance payment (37% vs. 25%) expected for generic medications compared to brand-name options, as well as the fact that manufacturers of generics do not provide discounts toward a beneficiary’s total out-of-pocket spending, unlike what is mandated by the Affordable Care Act for brand-name therapies. “This is a pernicious effect of the release of a generic and an unfortunate effect of Medicare rules,” Dennis Bourdette, MD, one of the study’s co-authors, said. A proposal by U.S. President Donald Trump's administration addresses this by eliminating manufacturer discounts from the calculation to determine a patient’s total out-of-pocket spending. Such strategy would reduce the disparity between brand-name and generic therapies, the researchers said. “In this study we found that Medicare beneficiaries with MS who require a [DMT] face considerable policy-related access restrictions and high out-of-pocket spending,” the researchers wrote. “There is an urgent need for policies that slow the growth of drug prices, improve access, and shield patients from excessively high out-of-pocket spending,” they concluded.

Since the first of this year, hospitals in the U.S. have been under new government orders. They must make their “list price” for specific services — things like an MRI or an infusion — available to the public by posting them online. The requirement was announced last summer. In…

We all know how expensive health insurance can be. On the social media sites that I browse, I always see stories of people with MS who find themselves in a bind due to the healthcare system in the U.S. Some can’t work because their MS has robbed them of…

The Scottish Medicines Consortium (SMC) issued a negative recommendation on the use of Fampyra (fampridine; marketed as Ampyra in the U.S.) in the National Health System (NHS), for the…

MS medications are expensive in the United States. We all know that. We also know that some of those expensive meds are a lot less expensive in places like Canada and Mexico. Now comes a novel idea from the nonprofit health insurance provider PEHP, which covers state workers and…

Many of us have received help to pay for our MS medications. Now there’s a chance that assistance could be threatened. A recent article in the The Wall Street Journal reports that U.S. government prosecutors are looking into whether some pharmaceutical companies’ patient assistance programs are on the wrong…

Often-overlooked MRI Signal May Aid in Early Diagnosis of MS, Other Brain Conditions, Study Suggests A part of an MRI scan that radiologists call a “background signal” is what’s being looked at. It’s usually ignored because the signal doesn’t seem to change even when a patient is…

Four disease-modifying therapies (DMTs) for  multiple sclerosis — Avonex, Rebif, Betaferon, and Copaxone — are cost-effective and reduce disease progression in MS patients, especially those with relapsing-remitting disease, according to 10-year, real-world results from U.K.’s MS Risk Sharing Scheme (RSS). But the long-term benefits observed wane over…

Is quadrupling the price of a medication “moral”? One pharmaceutical CEO not only thinks so, but he also says it’s a “moral requirement.” The medication is liquid nitrofurantoin, an antibiotic mixture that’s primarily used to treat bladder and urinary tract infections. Since UTIs can be a problem for people…

The National Institute for Health and Care Excellence, better known as NICE, issued a final decision against including Ocrevus (ocrelizumab) as a treatment for primary progressive multiple sclerosis (PPMS) in the subsidized public health system for England and Wales. The agency’s “final appraisal,” which mirrors its draft…

I get my medications the old-fashioned way. When I need to fill a prescription, I either go to the drug store or use a mail-order pharmacy — and usually, I have a copay. Sometimes the copay is just a few dollars, but sometimes it can be a few hundred.

Pendopharm’s Glatect (glatiramer acetate injection), a lower cost alternative to Teva’s Copaxone, has been added to the public health plans of five Canadian provinces for patients with…

If you’re going to buy a car, do you limit your shopping to just one car dealer? If you need gas, do you drive past three inexpensive service stations because someone told you to fill up at a fourth, where the price is much higher? I don’t think so.

Every time you post something on social media, pay a bill online, or make an online purchase you leave behind little data footprints. Now, an extensive report by National Public Radio and the nonprofit news organization ProPublica is pulling the curtain back on companies who are…

I was talking on the phone with a friend who also happens to have MS. I warned her the extra noise was from me opening the stack of mail I’d been avoiding for a couple of weeks. I have my bills set up for auto-pay, so I was in…

A couple weeks ago, I wrote a column about medical bills suggesting that you trust, but verify those charges. A few days ago, I read about a type of emergency room fee that’s hard to trust. It’s being charged by many hospitals, seemingly without consistency, and it can…

The Multiple Sclerosis Association of America (MSAA) announced that it will expand its MRI Access Fund to help meet the growing demand for magnetic resonance imaging (MRI) tests within the multiple sclerosis (MS) community. The fund is designed to help cover the costs of brain and spinal MRI scans…

It’s not unusual for someone with MS to have an annual MRI exam. Sometimes it’s even semiannual. And it’s not cheap. According to the website Healthcare Bluebook, an MRI of the brain, with and without contrast, can cost you anywhere from $826 to $4,780, depending on where you live…

“Trust, but verify” was a key concept during the U.S.-Soviet nuclear negotiations of the 1980s. “Trust,” President Ronald Reagan would say, “but verify” that what’s being said is actually being done. I apply that same concept to my bank, trusting that it has all of my checking account information…

MS medications are expensive. Many people with MS are able to afford their high prices only because their insurance covers most of the cost, and what remains as their copay is often covered by many of the pharmaceutical companies that produce those meds. The companies offer patient assistance…

In the United States, the government can do very little to control the costs of our expensive MS medications. In the United Kingdom, it’s a different story. The U.K. has an organization called the National Institute for Health and Care Excellence, better known as NICE. NICE provides healthcare…

After an agreement to lower their prices, four treatments for relapsing multiple sclerosis — Biogen’s Avonex and Merck KGaA‘s Rebif (both interferon beta-1a), Novartis’ Extavia (interferon beta 1b), and Teva’s Copaxone (glatiramer acetate) — were recommended as cost-effective and long-term therapy options within the National Health Service…

A new survey by the Kaiser Family Foundation finds that healthcare costs in the U.S. are increasing faster than general inflation. As character Private Gomer Pyle used to say on his 1960s TV show, “Surprise, surprise, surprise!” Really, those of us with a medical problem such as MS…

Here in the U.S., the price we pay for medications is complicated. The usual process is for a pharmaceutical company to set a high price for a medication when it first hits the market. But, like buying a car, that “sticker” price is negotiable. Health plans use pharmaceutical benefit…

As we all know, the cost of prescription medications can be outrageous. Disease-modifying therapies aside, even with insurance, the medications we get from a pharmacy can take quite a bite out of a budget. Though many people don’t know it, there are times when it can actually be…

You know about credit cards that offer you cash back for the items you buy. How about getting cash back for selecting specific healthcare service providers for things like medical tests and lab work? Go to your insurance company’s website, then enter your zip code and the service…