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Laura Joszt
Even as more competition entered the market, the prices of self-administered disease-modifying therapies for multiple sclerosis (MS) rose steadily from 2006 to 2016, and seniors with Medicare Part D coverage saw a 7.2-fold increase in out-of-pocket costs.
Over the 10-year period from 2006 to 2016, the price of self-administered disease-modifying therapies (DMTs) for multiple sclerosis (MS) rose so sharply that seniors with Medicare Part D coverage saw a 7.2-fold increase in out-of-pocket costs, according to new research published in JAMA Neurology.1

Researchers from the University of Pittsburgh assessed prices, market share, and spending on self-administered DMTs for MS (ie, glatiramer acetate, interferon β-1a, interferon β-1b, fingolimod hydrochloride, teriflunomide, dimethyl fumarate, and peginterferon β-1a). The study used claims data from 2006 to 2016 for a 5% sample of Medicare beneficiaries, which was approximately 2.8 million beneficiaries per year.

"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," study senior author Inmaculada Hernandez, PharmD, PhD, assistant professor of pharmacy at the University of Pittsburgh, said in a statement.

Before 2009, there were only 4 self-administered DMTs to treat MS on the market in the United States, but since then 7 branded drugs entered the market. The annual cost of treatment for each agent increased at a mean rate of 12.8% annually, the authors wrote. They note that fingolimod and brand-name glatiramer, 20 mg, were consistently at the higher end of the cost range; interferon β-1b (Extavia) and generic glatiramer, 20 mg, were on the lower end during the study period.

Over the study period, spending by Medicare on these treatments increased 10.2-fold from $7794 to $79,411 per 1000 Medicare beneficiaries. Patients’ out-of-pocket costs increased 7.2-fold from $372 to $2673. The authors estimated that over the 10-year period, Medicare Part D spending increased in total from $396.6 million to $4.4 billion, and out-of-pocket costs increased in total from $18.9 million to $149.4 million.

"We're not talking about patients without health insurance here," Hernandez said. "We're talking about insured patients, under Medicare. Still, they are paying much more for multiple sclerosis drugs than they were 10 years ago."

In an accompanying editorial,2 authors from Oregon Health & Science University highlighted the “disturbing trend” that prices were increasing in parallel, and noted that the entry of new products seems to only propel costs higher.

Currently, there are 19 FDA-approved DMTs for MS, and prices continue to rise for these drugs. The authors acknowledge pharma’s argument that rising costs reflect research and development costs, but they point to the continuously increasing prices of the original 3 drugs approved.

Neurologists, they wrote, should care about the rising costs and should also seek to minimize financial burdens on patients just as they would minimize physical adverse effects of treatments. The authors pointed to Mylan’s generic formulation of glatiramer acetate, which dropped in price and is now the lowest-cost DMT on the market.

They encouraged neurologists to engage with pharmaceutical and biotechnology companies about unreasonable price increases and to urge law makers to pass legislation targeting these rising drug prices for MS therapies.

“Remaining silent should not be an option,” the authors wrote. “The development of DMT for MS has been one of the great achievements of neurology in the past 25 years. Neurologists should not allow the unfettered increases in price for these drugs hurt the health care system or patients.”


1. San-Juan-Rodriguez A, Good CB, Heyman RA, Parekh N, Shrank WH, Hernandez I. Trends in prices, market share, and spending on self-administered disease-modifying therapies for multiple sclerosis in Medicare Part D [published online August 26, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.271.

2. Hartung DM, Bourdette D. Addressing the rising prices of disease-modifying therapies for multiple sclerosis [published online August 26, 2019]. JAMA Neurol. doi:10.1001/jamaneurol.2019.2445.

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