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 Before 2009, only four drugs were available to reduce symptoms and
slow the progression of multiple sclerosIs (MS), a disabling
autoimmune disease that damages the central nervous system and can
lead to fatigue, pain, vision loss and impaired coordination and
motor skills. Since 2009, seven new drugs have entered the U.S.
market.
To assess shifts in costs after the debut of so many new medicines,
researchers examined the annual cost of treatment for Medicare Part
D drug plans based on doses of each injected medicine recommended by
the U.S. Food and Drug Administration.
Over the decade-long study period, Medicare spending on MS drugs
surged 10.2-fold, from an average of $7,794 to $79,411 a year,
researchers report in JAMA Neurology.
Patients' out-of-pocket spending soared 7.2-fold from $372 to $2,673
a year on average.
"Such an increase in patients' out-of-pocket spending is
particularly worrisome because it may jeopardize patient access to
medications," said Alvaro San-Juan-Rodriguez, lead author of the
study and a researcher at the University of Pittsburgh School of
Pharmacy
"We hope that our work will serve as a call to action to address the
pressing issue of rising drug prices; thus, ensuring the
affordability and access to specialty medications and the best
possible outcomes for patients," San-Juan-Rodriguez said by email.
The study wasn't a controlled experiment designed to prove whether
or how price hikes might have directly impacted patients' access to
medications, and the study also didn't look at any negative health
outcomes that might be associated with stopping or reducing
medication use due to costs.
Another limitation of the study is that researchers lacked data on
rebates that drugmakers may pay to Medicare, which would reduce the
total amount of spending on these drugs.
Another drawback is that the study only looked at self-administered
drugs that patients can get at the pharmacy and inject themselves at
home. The study didn't look at medicines that are only available in
doctors' offices such as Tysabri, which is commonly prescribed for
MS, or medicines that are available by infusion and covered by
traditional Medicare, not by Medicare drug plans.
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Before 2009, four self-administered disease modifying MS drugs were
available in the U.S.: Copaxone, Avonex, Rebif, and Betaseron. Since
then, seven more have hit the market: Extavia, Gilenya, Aubagio,
Tecfidera, Copaxone (at a higher dose), Plegridy, and Glatopa.
Older drugs and generics aren't necessarily cheaper for Medicare or
for patients than newer brand-name drugs, making it even harder for
patients to figure out how to best lower their out-of-pocket
spending on medicine, San-Juan-Rodriguez said.
"Although generics are generally cheaper than brand names drugs, the
use of generic specialty medications does not lead to lead to
savings for Medicare Part D beneficiaries," San-Juan-Rodriguez said.
"On the contrary, due to incentive misalignments created by the
Medicare Part D benefit design, beneficiaries using generic drugs
such as Glatopa (generic version of Copaxone) may pay more than
those using the branded drug."
And price hikes can also mean access problems for patients who may
find their insurance stops covering certain drugs or raises the
share of the bill passed to patients as out-of-pocket fees," said
Dr. Dennis Bourdette, chair of neurology at the school of medicine
at Oregon Health & Science University and author of an editorial
accompanying the study.
"Because of the high cost of these medications, insurance carriers
seek to control expenses by limiting access to these drugs,"
Bourdette said by email. "Patients should look carefully when
choosing insurance carriers at co-pays and what limitations to
access the insurance company has."
SOURCE: http://bit.ly/341PiPL JAMA Neurology, online August 26,
2019.
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