Trends in Spending and Pricing of Disease-Modifying Therapies for MS

A new study from investigators at the University of Pittsburgh paints a grim picture for Medicare patients with multiple sclerosis (MS) in the face of rising drug prices. 



The study revealed that out-of-pocket costs have risen more than sevenfold — with annual list prices for these treatments rising from around $18,000 to $76,000 per patient annually — for Medicare Part D beneficiaries in a 10-year period lasting from 2006 to 2016.

"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," said study senior author Inmaculada Hernandez, PharmD, PhD, assistant professor of pharmacy at Pitt.

In an effort to evaluate trends in prices, market share, and spending on self-administered disease-modifying therapies (DMT) for MS, investigators carried out a review of Medicare claims data from 2006 through 2016. DMT claims included in the study were for glatiramer acetate, interferon beta-1a, interferon beta-1b, fingolimod hydrochloride, teriflunomide, dimethyl fumarate, and peginterferon beta-1a.

The main outcome measures of the study were annual cost of treatment with each medication, market share of medication, and pharmaceutical spending per 1000 Medicare beneficiaries for all drugs. Cost of treatment was defined as Medicare Part D prescription claims gross costs and US Food and Drug Administration-approved recommended dosing. Whereas, market share was defined as proportion of pharmaceutical spending account by every drug.

Additionally, investigators analyzed relative contributions of Medicare Part D Plans’ payments, Medicare catastrophic coverage payments, low-income cost-sharing subsidies, patients’ out-of-pocket costs, manufacturers’ coverage gap discounts, and other payments toward pharmaceutical spending.

Upon analyses, results revealed that annual costs of treatment had more than quadrupled from 2006 to 2016 with a mean of $18,660 in 2006 rising to $75,847 in 2016 and at a mean rate of 12.8% every year. Glatiramers accounted for the largest market share during the study period — ranging between $25 552 of $79 411 per 1000 Medicare beneficiaries (32.2%) and $10 342 of $21 365 per 1000 Medicare beneficiaries (48.4%).

Investigators noted a drop among platform therapies from 2006 to 2016 in favor of new therapies including glatiramers (per 1000 Medicare beneficiaries: $2861 of $7794 (36.7%) to $25,552 of $79,411 (32.2%)), interferon beta-1a (30 μg; per 1000 Medicare beneficiaries: $2521 of $7794 (32.3%) to $11 298 of $79 411 (14.2%)), interferon beta-1b (Betaseron; per 1000 Medicare beneficiaries: $1460 of $7794 (18.7%) to $3588 of $79 411 (4.5%)), and interferon beta-1a (8.8/22/44 μg; per 1000 Medicare beneficiaries: $951 of $7794 (12.2%) to $6588 of $79 411 (8.3%)). Investigators also noted market share increases in fingolimod (to $6311 of $79 411 per 1000 Medicare beneficiaries (7.9%)), teriflunomide (to $7177 of $79 411 per 1000 Medicare beneficiaries (9.0%)), and dimethyl fumarate (to $15 262 of $79 411 per 1000 Medicare beneficiaries (19.2%)). 



During the course of the study, pharmaceutical spending per 1000 beneficiaries increased 10.2-fold ($7794 to $79,411) and out-of-pocket patient spending per 1000 beneficiaries increased 7.2-fold ($372 to $2673). Investigators also noted the relative contribution of federal payments toward pharmaceutical spending increased from $5335 of $7794 (68.5%) to $58,620 to $79,411 (73.8%).

This study, “Trends in Prices, Market Share, and Spending on Self-administered Disease-Modifying Therapies for Multiple Sclerosis in Medicare Part D,” was published online in JAMA Neurology.