For Medicare Patients, Costs of MS Drugs Rise Sevenfold Over 10 Years

Medicare patients with multiple sclerosis (MS) saw their medication costs soar by more than sevenfold over a decade, a new study finds.

It's no secret that the costs of MS drugs have skyrocketed in recent years. When the first so-called disease-modifying drugs were approved starting in the 1990s, they cost roughly $8,000 to $11,000 per year, according to the National Multiple Sclerosis Society.

Today, the list prices on those same drugs top $80,000 per year -- even though many more MS drugs have entered the market.

Instead of driving down prices, competition has fueled the reverse. As each new drug came to the market with a bigger price tag, the price on older drugs was bumped up to meet it.

The new study, researchers said, highlights the ultimate costs to the Medicare program, and to older Americans themselves.

"We want to bring this to the attention of policymakers," said senior researcher Inmaculada Hernandez, an assistant professor of pharmacy at the University of Pittsburgh.

Her team found that between 2006 and 2016, Medicare spending on disease-modifying drugs shot up 10-fold. Meanwhile, patients saw a more than sevenfold increase in their personal costs -- from $372 per 1,000 beneficiaries, to $2,673 per 1,000.

Altogether, the researchers estimate that MS drugs cost the Medicare program $4.4 billion in 2016 -- up from $397 million a decade earlier. Patients' annual share of the cost soared from $19 million to almost $150 million.

"That's a tremendous increase in costs to patients," said co-researcher Alvaro San-Juan-Rodriguez, a pharmacy fellow at Pitt. "It's worrisome."

The National MS Society agrees. "Medications can change lives only if they are accessible -- a sevenfold increase in out-of-pocket costs is not accessible," said Bari Talente, executive vice-president of advocacy for the society.

"People with MS, Medicare and our health care system cannot continue to face these types of increases, where prices more than quadruple over a 10-year period," Talente said.

MS is a neurological disorder caused by a misguided immune system attack on the body's own myelin -- the protective sheath around nerve fibers in the spine and brain. Depending on where the damage occurs, symptoms include vision problems, muscle weakness, numbness, and difficulty with balance and coordination.

Most people with MS have a form where symptoms flare up for a time, then ease. Disease-modifying drugs can reduce the frequency and severity of those symptom flares, and slow down the progression of disabilities, according to the National MS Society.

Some are given by infusion in a doctor's office. But many are injection-drugs taken at home, and they are the ones analyzed in the current study. They include older drugs like Betaseron (interferon beta-1b), Copaxone (glatiramer acetate) and Avonex (interferon beta-1a). Also included were newer ones such as Lemtrada (alemtuzumab), Glatopa (glatiramer acetate) and a higher-dose version of Copaxone.

At the beginning of the study period, only four disease-modifying drugs were on the market. Over the next decade, seven more branded drugs were approved, the researchers pointed out. Yet the competition propelled huge price increases, instead of declines.

"This [report] supports policy efforts to try to control these year-on-year increases," San-Juan-Rodriguez said.

An editorial published with the study in JAMA Neurology puts it bluntly: It's not only MS patients, but U.S. taxpayers, who are footing the bill for these "irrationally priced" medications.

The Medicare program is prohibited from negotiating prices with drug companies, noted Dr. Dennis Bourdette and Daniel Hartung, of Oregon Health & Science University. But, they write, many have argued that direct negotiations could slash prices -- similar to what is done in the Department of Veterans Affairs.

Tom Wilbur, a spokesperson for Pharmaceutical Research and Manufacturers of America, described the MS drug market as "unique."

That, he said, is because of "the nature of the disease and the need for patients to maintain broad access to a range of therapies. The MS market is becoming increasingly competitive due to the entry of additional generics and brand-name medicines."

Wilbur said the group supports measures to help Medicare patients afford the drugs, like "sharing the savings from rebates directly at the pharmacy counter."

According to Talente, the National MS Society has been calling for various "much needed changes to the prescription drug supply chain" -- including caps on out-of-pocket costs to Medicare patients and policies that address price increases themselves.

She noted that there are now cheaper generics available for one of the disease-modifying drugs (Copaxone). But that hasn't made a dent in overall prices.

They are "even higher today than when this study period ended," Talente said.

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