What Can We Do About The High Cost Of Multiple Sclerosis Drugs?

An analysis of Medicare Part D prescribing patterns was recently published. Although neurologists comprise only 1.2% of all physicians, they are responsible for 4.8% of total drug payments, third highest of all specialties. Within this group, multiple sclerosis drugs have the highest payments.

Retail drug prescription spending was the third largest category of healthcare spending in the United States in 2013, approximately $271 billion. Hospital care at $937 billion and physician and clinical services at $587 billion were number one and number two. Neurologists have one of the highest total prescription and per claim cost despite a relatively small number of physicians.

Multiple sclerosis drugs comprised 44% of total payments for drugs prescribed by neurologists. For the 9 medications available in 2013, cost ranged from a low of $4149 per month for Aubagio to $5017 per month for Gilenya.

Antiepileptic drugs were the second highest category, accounting for 12% of total payments for drugs prescribed by neurologists. Generics consisted of 34% of the total in dollars, whereas generics consisted of 86% of the total prescriptions. The discrepancy can be explained by the fact that brand antiepileptic drugs, though a small percent of total prescriptions, may cost over $700 per month compared to generics available at $20 or $40 per month.

The third highest category was dementia medications, 9.4% of the total of neurologist-prescribed drugs. Generics comprised 12% of the dollars and 54% of the number of prescriptions. Non-neurologists were responsible for a higher proportion of these drugs than neurologists. Namenda (memantine) was responsible for $1.5 billion in payments from any provider, far greater than payments to neurologists for all services over the course of a year. Even more galling, to me, is the fact that most experts believe that this drug has marginal benefits.

Parkinson’s disease comprised the fourth highest category, 8% of total payments. Generics were 56% of the payments and 90% of the number of prescriptions. Fifth highest was neuropathic pain medications.

Don’t blame neurologists for these problems. The proportion of generic prescriptions by neurologists is very high, but the costs of the brand drugs outweigh this. This is especially true for MS. In 2013, no generics were available. Now, one generic is available but priced not significantly lower than brands. Pharmaceutical companies do not compete on price. Thus, neurologists have few alternatives to reduce the cost of MS drugs.

See Neurology, April 19, 2016, page 1491.

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Should More Disabled Multiple Sclerosis Patients Stop Their Disease-Modifying Drug?

A minority of MS experts believe that patients with higher disability from secondary progressive Multiple Sclerosis will not respond to a disease-modifying drug and thus do not need to be treated. There is a “window of opportunity” to diagnose MS as early as possible, treat it appropriately, and reduce the risk of this occurring. But what to do when patients begin to accumulate disability and move from an Expanded Disability Status Scale (EDSS) of 3 to 4 and then 6? A score of 6 means that an assistive device, such as a cane, is needed and that the walking distance is reduced. Patients may take 20 years or may never reach an EDSS score of 3, but once they do, they tend to move rapidly from 3 to 4 and then to 6.

A new study presented at ACTRIMS 2016 Forum has concluded that in this patient group, using a “higher-efficacy immunomodulatory therapy” leads to reduced risk of accumulating further disability.

According to the lead author, Dr Nathaniel Lizak, “these observations justify treatment even after moderately advanced disability has been attained.”

See Neurology Reviews, April 2016.

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Fullerton Neurology Multiple Sclerosis Disease-Modifying Drug
Multiple Sclerosis Disease-Modifying Drug