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 Researchers examined data on out-of-pocket drug costs from 2004 to
2016 for more than 912,000 people with private health insurance who
had multiple sclerosis, peripheral neuropathy, epilepsy, dementia or
Parkinson's disease.
All of the patients took at least one medication to treat these
disorders, and researchers tracked costs for the most commonly
prescribed and most expensive drugs for each condition.
By far, costs rose the most for multiple sclerosis medicines.
Patients' average monthly out-of-pocket costs for these drugs
increased from $15 in 2004 to $309 in 2016.
Patients' cumulative out-of-pocket costs over the first two years
after diagnosis were $2,238 for multiple sclerosis, 10-fold higher
than the $230 paid out-of-pocket by newly diagnosed epilepsy
patients. Multiple sclerosis patients with the highest costs spent
$9,855 over two years, compared to $865 for epilepsy.
"Our study demonstrated that out-of-pocket costs have risen from
being negligible to quite substantial for certain medications over
the past 12 years," said lead study author Dr. Brian Callaghan of
the University of Michigan in Ann Arbor.
"This matters for patients because out-of-pocket costs can cause
financial hardship and potentially decrease medication adherence,"
Callaghan said by email.
Out-of-pocket costs are surging for many reasons. One culprit is the
debut of newer injectable biotech drugs that have higher price tags
than older generic pills, researchers note in Neurology. Another is
the rising popularity of high-deductible health plans that have
lower insurance premiums but typically require patients to pay
higher out-of-pocket fees at the pharmacy.
With high-deductible health plans, people paid more than twice as
much out-of-pocket for multiple sclerosis drugs. In 2016, multiple
sclerosis patients with high-deductible plans paid an average of
$661 per month compared to $246 per month for those in
low-deductible plans.
While shifts in out-of-pocket costs for brand name medications
varied by drug and disease, patients generally encountered increases
in their costs for medicines to treat dementia and Parkinson's
disease, the researchers found.
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The study didn't include every drug to treat the five neurologic
conditions it examined, and it only focused on medicines for certain
diseases.
It's also unclear from the study how much rising out-of-pocket costs
might lead patients to delay or skip needed refills, or how much
expensive drugs might help curb utilization or spending on hospital
or physician services, said Geoffrey Joyce, chair of pharmaceutical
and health economics at the University of California School of
Pharmacy in Los Angeles.
"There is less price sensitivity for life-saving drugs," Joyce, who
wasn't involved in the study, said by email. "For example, raising
the out-of-pocket price for a specific allergy medication will have
a larger effect on its use (because they are non-essential and there
are other therapeutic substitutes including over-the-counter) than
changes in the out-of-pocket price of a cancer medication or drugs
to treat multiple sclerosis."
The conditions in the study can be life-threatening if not properly
managed with medications, said Stacie Dusetzina, a health policy
researcher at Vanderbilt University School of Medicine in Nashville,
Tennessee, who wasn't involved in the study.
"For example, other studies have found that patients with epilepsy
who do not take their medications as prescribed have a higher risk
of emergency department use, hospital admissions, injuries and
death," Duzetzina said by email. "The good news here is that many of
the conditions studied have affordable treatment options."
Patients should speak up when costs are too high, said Dr. Aaron
Kesselheim of Brigham and Women's Hospital and Harvard Medical
School in Boston.
"The most important thing they can do is to tell their doctors about
these cost issues, since many physicians are unaware of how much
their patients pay for medications," Kesselheim said by email. "In
certain cases, there may be a lower-cost generic alternative that
would work just as well."
SOURCE: https://bit.ly/2u4zomO Neurology, online May 1, 2019.
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