Adherence Lacking to High-Cost Multiple Sclerosis Disease-Modifying Drugs

Patients with multiple sclerosis (MS) have total health care costs that are 8.3 times higher than individuals without MS, with disease-modifying drugs (DMD) accounting for more than 80% of these excess costs, according to a pair of studies by pharmacy benefit manager Prime Therapeutics.

The research, presented at the Academy of Managed Care Pharmacy Managed Care and Specialty Pharmacy 30th Annual Meeting, analyzed 4 million commercially insured Prime members younger than 65 years of age who were continuously enrolled from October 2013 to September 2017. Of the members who met the study criteria, 8356 had claims associated with an MS diagnosis.

In the first study, the authors evaluated total pharmacy and medical claims data for 12 months among patients with MS and a matched group of individuals who did not have MS. The authors sought to evaluate the percentage of patients with MS treated with a DMD and the percentage who maintained adherence to DMDs over the 12-month period.

The authors defined adherence as patients who showed 80% or greater proportion of days covered with a DMD. The findings showed that the per patient per year (PPPY) total pharmacy and medical claims cost was $84,712 for patients with MS who had a claim for a DMD, of which, $68,544 (80.9%) was attributed to spending on DMDs.

The PPPY total claims cost for all patients with MS in the study, regardless of DMD use, was $63,200. Of this total, $45,231 (71.6%) were for DMDs and $17,884 (28.4%) were for all other medical and pharmacy claims, according to the study. The total annual cost of $63,200 is 8.3 times higher than the $7642 annual cost for individuals who do not have MS.

Patients with MS had an additional cost of $10,301 PPPY for expenses not related to DMDs, such as MRIs, non-DMD specialty drugs, hospital inpatient stays, and physician office visits, according to the authors.

In the second study, the authors evaluated 4753 individuals with a claim for a DMD from October 2013 to September 2014 to determine an association between adherence and MS relapse. In the following 3 years, 2859 (60.2%) patients were deemed adherent to their DMD regimen compared with 1894 (39.8%) who were not adherent. Switching DMDs was permitted under the adherence measure during the 3-year period.

The authors found that 991 patients with MS experienced moderate-to-severe relapses at an average cost of $8866 per patient. Of the 2859 patients deemed adherent, 520 (18.2%) had claims evidence of a relapse compared with 471 (24.9%) of the 1894 patients with MS found to be non-adherent.

The authors found that 3 years of adherence to a DMD was associated with a statistically significant (7 percentage point) reduced incidence of moderate-to-severe clinical relapse. The study results indicate that, on average, improved adherence to a DMD regimen among 15 non-adherent patients with MS for 3 years would prevent just 1 of these patients from experiencing a moderate-to-severe relapse, according to the authors.

As such, the authors said that spending $3 million to achieve adherence to a DMD regimen in all 15 members for 3 years would avoid a projected $9000 in medical costs for treatment of moderate-to-severe relapses in 1 patient, which translates to an investment of $333 to save just $1 in direct medical costs.

“This real-world study shows that DMD adherence was associated with a significant decrease in relapses, which is a major goal of therapy,” Kevin Bowen, MD, principal health outcomes researcher at Prime, said in a press release. “These findings provide us with a better understanding of the value of improving DMD adherence and the magnitude of offsetting direct medical cost. Multiple studies attempting to assess the total value of DMD therapy have concluded use of MS DMDs greatly exceeds conventional thresholds for cost-effectiveness without large reductions in the prices of these drugs. This study only measured direct costs for relatively short periods of time. The value of treating more MS members with DMDs or improving adherence needs to be assessed from a societal perspective and over decades.”