Therapy Costs Increase More Than Sevenfold for MS Patients on Medicare, 10-Year Study Reveals

The out-of-pocket costs for self-administered disease-modifying therapies (DMTs) for multiple sclerosis (MS) patients on Medicare increased more than sevenfold from 2006 to 2016, according to a new study.

This was reported by researchers at the University of Pittsburgh in a study, “Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis in Medicare Part D,” which was published recently in the journal JAMA Neurology.

A total of 11 branded DMTs have become available for people with MS since 2009. Previous studies have shown that prices of these therapies have increased at higher rates than specialty medications used to treat other diseases, leading to higher out-of-pocket costs for patients.

Researchers now evaluated claims data from Medicare from 2006 through 2016 to assess changes in the annual costs related to self-administered DMTs for MS treatment.

The team analyzed data from 5% of Medicare PartD beneficiaries who were selected randomly, which represented a mean of 2.8 million Medicare beneficiaries per year. They included cost information related to the use of: Copaxone (glatiramer acetate, by Teva); Rebif (interferon beta-1a, by EMD Serono) and Avonex (interferon beta-1a, by Biogen); interferon beta 1b formulations like Betaseron (by Bayer HealthCare) and Extavia (by Novartis); Gilenya (fingolimod, by Novartis); Aubagio (teriflunomide, by Sanofi Genzyme); Biogen’s Tecfidera (dimethyl fumarate); and Plegridy (peginterferon beta-1a).

The market share — the proportion of the pharmaceutical spending market accounted for by each therapy — and pharmaceutical spending per 1,000 Medicare beneficiaries also were analyzed.

Researchers determined that the annual cost of treatment (before rebates, coupons, or insurance were included) increased from a mean of $18,660 to $75,847 from 2006 to 2016. This represented more than a fourfold increase and a mean annual rate increase of 12.8%.

It has been argued previously that the increasing cost of treatment may not necessarily result in increased spending due to manufacturer rebates or other discounts. But this study found that Medicare spending per 1,000 beneficiaries increased more than tenfold, from $7,794 to $79,411, while out-of-pocket expenses for patients increased more than sevenfold, from $372 to $2,673, over a 10-year period.

“We wanted to see how increases in list prices translated to increases in out-of-pocket spending, and we discovered that actual price increases do get passed down to patients, and that can negatively affect access,” Inmaculada Hernandez, PhD, assistant professor of pharmacy at Pitt and the study’s senior author, said in a press release. “We’re not talking about patients without health insurance here. We’re talking about insured patients, under Medicare. Still, they are paying much more for multiple sclerosis drugs than they were 10 years ago.”

The team also found that even though there has been increased market competition for the most popular therapies (including Copaxone, Tecfidera, and Avonex) over time, with the prices for the majority of these therapies rising. Gilenya and Copaxone had the highest annual costs of treatment during the 10 years assessed, while Extavia and generic formulation of glatiramer (marketed by Sandoz as Glatopa) had the lower costs.

“One of the most significant findings was that the prices of these drugs have increased in parallel,” said Alvaro San-Juan-Rodriguez, a pharmacy fellow at Pitt and lead author of the study. “Only a couple exceptions deviate from that general trend.”