MS Spending Spiked Over the Past Decade as Costly DMTs Emerged, Reports at ISPOR Show

A new report shows just how much disease modifying therapies (DMTs) have changed the economic landscape of treating multiple sclerosis.

A new report shows drug spending on patients with multiple sclerosis rose sharply over the decade from 2008 to 2018, highlighting the economic impact of new disease-modifying therapies (DMTs).

The report, presented earlier this week at Virtual ISPOR 2020, was based on data from patients enrolled in Medicaid. The analysis was conducted by investigators from the University of Cincinnati.

Overall, annual MS drug utilization jumped from $85,209 in 2008 to $194,877 in 2018, a slight decrease from a peak of $223,604 in 2016.

Primary author Zizi Elsisi, BPharm, MS, told The American Journal of Managed Care® in an interview she was not surprised to see spending go up, since other studies have documented the “skyrocketing” prices of DMTs. However, she said this study showed the dramatic way those prices have translated to increased Medicaid spending.

“It was both surprising and alarming to see this rise in this population,” she said.

Annual reimbursement for Medicaid patients surged by 633% over the decade covered in the study. Back in 2008, the annual reimbursement was just $172 million; by 2017 it had reached $1.4 billion, before falling slightly to $1.26 billion in 2018.

Those findings were echoed in a second study presented at ISPOR, which looked specifically at the self-administered DMTs for MS. The report found list prices jumped an average of 13.4% per year between 2007 and 2019. By the end, the annual cost of treatment for self-administered DMTs had risen to $93,496.

Though the overall trajectory was an acute increase, both studies noted a leveling off in prices at the tail end of their respective study periods. In the case of Elsisi’s study, costs peaked in 2016, but dropped slightly by 2018. Elsisi said further analysis would be necessary to conclusively establish the causes of the dip, but she suggested a couple of potential reasons.

One possible reason is a decrease in the use of dimethyl fumarate (Tecfidera) in favor of ocrelizumab (Ocrevus). The former is a twice-daily pill, while the latter is a twice-annual infusion. On an annualized basis, ocrelizumab has a lower price, and Elsisi said many patients find an occasional infusion more convenient than remembering to take a pill twice a day.

Elsisi said the decline could also have resulted from decreased overall purchases and/or the availability of generics. However, she said it’s difficult to know if the downward trend might continue.

“More specialty/biological drugs are entering the market and these can drive spending and utilization up,” she noted. “For example, in 2019 alone, 3 new DMTs were approved.”

Elsisi and colleagues also noted a sharp rise in the price per prescription for most brand-name drugs. For instance, Medicaid paid $2033 per prescription for natalizumab (Tysabri) in 2008, but by 2018 the government insurer was paying $5114. Alemtuzumab (Lemtrada) jumped from $19,138 in 2016 to $23,588 2 years later.

Though her study dealt specifically with Medicaid patients, Elsisi said available data suggests commercial insurers saw a similar increase in spending. “We expect that the costs are increasing sharply in commercially insured patients, and probably at a higher rate than in the Medicaid population,” she said.


Elsisi Z, Hincapie AL, Guo JJ. Expenditure, utilization, and cost of specialty drugs for multiple sclerosis in the US Medicaid population, 2008-2018.

Presented at: ISPOR 2020; May 18-20, 2020; Abstract PRO52

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