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

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.”

Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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Patricia holds her Ph.D. in Cell Biology from University Nova de Lisboa, and has served as an author on several research projects and fellowships, as well as major grant applications for European Agencies. She also served as a PhD student research assistant in the Laboratory of Doctor David A. Fidock, Department of Microbiology & Immunology, Columbia University, New York.
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7 comments

  1. Terry says:

    Before my husband retired, I was covered by his company insurance rather than Medicare. While copays for a 90 supply of the various DMT’s I took were high, they were at least somewhat affordable. Then I discovered copay assistance from the manufacturer’s which made them even more so and didn’t break the bank. The caveat…one must have regular insurance, not Medicare.

    He retired and I was forced to go on to Medicare at that time. Most Part D Prescription plans do not cover DMTs unless one goes through concessions, pre-approvals and hoop jumping. I was able to get Tecfidera covered…for $2800 a month. That is multiple house payments for us.

    If on a government program like Medicare…there is no co-pay assistance like the one I could use while with United Healthcare. BUT! One can get grants for financial assistance on MS drugs if one is on Medicare. I applied and was approved for $6000 for the year. That would cover approximately 2 months of Tecfidera that costs $2800 per month.

    While disheartened, I figured there may be someone who needed that grant money more than me.

    I no longer take Tecfidera or any DMT.

    • Tess says:

      What you state is true. I take Copaxone and have for years. I did have to go after grants and got approved. I have to go through this nerve wracking hoop jumping every year in the hopes after Jan 1, I can get approved for another grant. Wracked nerves and stress just amplify my MS. But do you think these big pharma companies give a hoot?…NO. Good luck to all.

  2. Gary says:

    When I was diagnosed I had insurance through my employer. I was first given Rebif for a cost of $5900/month of which I paid just $75. I was let go from my employer(they were self-insured and I believe my diagnosis played a big part in their decision) thus I went on my wife’s insurance and was then given Ocrevus with was about $30,500/dose. Her insurance paid it all. I then moved to Medicare last year and the first dose I received was charged to Medicare for $102,000. I had a supplement and I had to pay $61.00. This is crazy.

  3. Charles Dick says:

    Expanded Medicare for all would fix all that. If we bring healthcare under a single payer system, then prices can be negotiated down. Currently the price of medications keeps getting ratcheted up by the interplay between insurance companies and pharmaceutical companies. That broken system really needs to be fixed.

  4. Mike Mallimo says:

    I’m curious to see how revenue and EBITs increased over that same period. Did the $ go to more R&D? What about income and pay packages for executives on the boards of these companies? And pay for the workers. My guess is these increases are largely related to corporate greed.

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