- Multiple sclerosis patients acutely felt the impact of rising list prices for their medications, according to research published Monday in JAMA that found typical Medicare out-of-pocket costs ballooned from $372 to $2,673 over a decade.
- Between 2006 and 2016, average list prices more than quadrupled from less than $20,000 a year to slightly more than $75,000. The study's authors, a group from the University of Pittsburgh and the UPMC Health Plan, calculated their findings based on a 5% random sample of Medicare Part D claims data.
- A related editorial, also published Monday in JAMA, stated the findings show "irrationally priced therapies" are being paid for by taxpayers and patients, with the entry of new therapies almost always driving prices higher.
While insulin may be the drug class most under scrutiny for its pricing, MS medicines have also been the subject of public and political pressure.
In 2017, two leading members of Congress launched an investigation into pricing practices for MS drugs, and an independent cost watchdog determined all but one MS medication were too expensive for their value.
(Sanofi's Lemtrada (alemtuzumab) was the sole drug that fell below thresholds set by the group, the Institute for Clinical and Economic Review.)
Nearly 20 disease-modifying treatments are approved by the Food and Drug Administration. Yet prices largely keep going up, the JAMA research found.
"These rising prices are not only concerning because of the strong effect they had on spending, but because they demonstrate that the approval of new therapies did not ameliorate and could have even contributed to high inflation rates observed for incumbent drugs," the study's authors wrote.
Data on rebates and discounts offered by drugmakers on their products wasn't available, however, limiting the conclusions the authors could draw.
Generics could offer MS patients some cost relief. Mylan set the price of its copy to Teva's Copaxone (glatiramer acetate) 60% lower than the branded version, making it the cheapest disease-modifying treatment on the market.
Low-cost copies of Novartis' Gilenya (fingolimod) also looked set to arrive soon, but a court injunction in June will keep them off the market until litigation between generic developers and the Swiss pharma is resolved.
One exception to the trend — which fell outside the scope of the study — is Roche's Ocrevus (ocrelizumab), approved in early 2017 and priced 20% lower than available treatments at the time of launch.
In the related JAMA editorial, Daniel Hartung, an associate professor at Oregon State University, and Dennis Bourdette, a neurology professor at the Oregon Health and Science University, made a call to action for neurologists.
Citing previous survey research that shows MS patients prioritize out-of-pocket expenses over a drug's effectiveness and safety, they argued doctors should take a medicine's "financial toxicity" into consideration as well.
"Neurologists should be seeking to minimize the financial adverse effects of these therapies as much as they try to minimize physical adverse effects," Hartung and Bourdette stated.
The authors said neurologists also should consider their relationships with these drugmakers and ask them for explanations of price increases. "Remaining silent should not be an option," they wrote.