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Study Finds Increased Out-of-Pocket Costs for Neurologic Treatments


In a study to be presented at the American Academy of Neurology’s annual meeting next week, May 4-10, 2019, in Philadelphia, Pennsylvania, researchers found that the out-of-pocket costs for neurologic medications have increased significantly over the past 12 years, particularly for those enrolled in high-deductible health plans.

In a study to be presented at the American Academy of Neurology’s annual meeting next week, May 4-10, 2019, in Philadelphia, Pennsylvania, researchers found that the out-of-pocket costs for neurologic medications have increased signficantly over the past 12 years, particularly for those enrolled in high-deductible health plans (HDHPs).

According to the study, medications prescribed by neurologists accounted for $5 billion in Medicare Part D payments in 2013; the only specialties with higher totals were internal medicine and family practice. Additionally, during this time, the proportion of patients in HDHPs rapidly increased from 8% in 2009 to 29% in 2016, resulting in a higher proportion of costs being shifted to patients. Investigators examined medication out-of-pocket costs and total estimated costs for 5 neurologic conditions, and they analyzed the effects of HDHPs on out-of-pocket costs and the cumulative costs for 2 neurologic conditions.

The authors utilized a database containing detailed medical and pharmaceutical claims for more than 73 million individuals insured by UnitedHealthcare from 2004 to 2016. The researchers then identified patients who had an outpatient visit with a neurologist linked to either multiple sclerosis (MS), peripheral neuropathy, epilepsy, dementia, or Parkinson Disease (PD), and had a neurologic medication prescribed within the following year. Included within the study were the top 5 most commonly prescribed medications for each condition based on Medicare data. However, the researchers also made several additions including all FDA-approved MS treatments, lacosamide as a brand-name epilepsy medication, and venlafaxine as a peripheral neuropathy medication that transitioned from brand to generic.

The primary outcome of the study was the mean out-of-pocket costs for a 30-day supply of a neurologic prescription, including copay and deductible payments associated with the drug. This was calculated with the understanding that a single patient often has multiple prescriptions for the same medication in the year following a diagnosis. Due to this, researchers first determined the patient-specific mean out-of-pocket cost, and then calculated the population mean out-of-pocket cost by averaging the patient-specific values.

Overall, researchers identified 105,355 patients with MS, 314,530 with peripheral neuropathy, 281,073 with epilepsy, 120,720 with dementia, and 90,801 with PD.


For the 8 MS drugs included in the study, monthly out-of-pocket costs were similar, however, these costs rose significantly throughout the timeline reviewed in the study. The authors found that in 2004, the mean monthly out-of-pocket cost was $15, and by 2016 it rose to $309.

Peripheral Neuropathy

From 2004 to 2016, researchers found that 2 drugs that had been generic for many years prior to the study had low monthly out-of-pocket and total costs. Another drug, which became generic in 2004, was seen to have declined in cost to similar levels for the previous 2 generics. Conversely, for medications only available as a brand-name product the researchers found that monthly out-of-pocket costs increased. Broken out by medication, monthly mean out-of-pocket costs in 2016 were $66 for pregabalin, $32 for duloxetine, $13 for tramadol, $12 for amitriptyline, $10 for venlafaxine, $8 for gabapentin, and $7 for nortriptyline.


Since 2010, monthly out-of-pocket and total costs for most of the drugs studied have remained stable, with the exception of carbamazepine, which has seen out-of-pocket costs increase from 2014 to 2016. While lacosamide total monthly costs have remained somewhat steady since 2009, the out-of-pocket costs have increased since 2010.


Monthly total costs remained similar for most drugs analyzed with the exception of donepezil which had steep declines after 2010 when the medication became generic. However, monthly out-of-pocket costs for rivastigmine and galantamine increased from 2014 to 2016.


Monthly total costs of carbidopa-levodopa and amantadine remained low throughout the time period studied. After 2 drugs became generic, their prices dropped significantly. Total costs for rasagiline remained stably high throughout the study, though costs rose from 2014 to 2016.

Researchers also determined the effect of HDHPs and cumulative costs for patients with MS and epilepsy. For patients with MS in HDHPs, out-of-pocket costs were $661 in 2016 while those in non-high deductible health plans had costs of $246. Though less extreme, patients with epilepsy in HDHPs had monthly out-of-pocket costs of $30 in 2016, compared with $18 for those not enrolled in high deductible health plans.

“For patients with MS, cumulative out-of-pocket costs were a mean of $2238 in the 2 years after diagnosis, which accounted for 77.4% of their total cumulative medication out- of-pocket costs,” wrote the authors. For patients with epilepsy, the cumulative out-of-pocket costs were $230 in the first 2 years after diagnosis, accounting for 21.7% of their total cumulative medication out-of-pocket costs.

The study found that out-of-pocket costs vary substantially both within and across neurologic conditions, even within the same medication. “The trajectory of out-of-pocket costs in recent years suggests that these costs are likely to further increase, particularly as more expensive neurologic drugs become available and high deductible health plans continue to increase. Neurologists should use out-of-pocket cost information to influence their prescribing practices, but first they must have this information available to them at the point of care,” concluded the authors.


Callaghan B, Reynolds E, Banerjee M, et al. Out-of-pocket costs are on the rise for commonly prescribed neurologic medications. Neurology. 2019; 92:1-10. Published May 1, 2019. Accessed May 1, 2019.

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