Multiple Sclerosis Drug Costs Account for More Than Two-Thirds of Patients' Total Cost of Care

A new study carried out by Blue Cross and Blue Shield of Minnesota and PBM Prime Therapeutics forecasts that multiple sclerosis specialty drug treatment cost will exceed $50,000 per person per year in 2016.

Multiple sclerosis specialty drug costs are the fastest growing category within the total cost of care, according to the results of a new study from Prime Therapeutics that were presented at the Academy of Managed Care Pharmacy’s 2012 Educational Conference. Costs for these medications are growing at 6.4 times the rate of all other medical costs, and from 2008 to the present, the price for self-injectable specialty drugs has increased from 16.3% to 22.6%.

Although increased utilization and adherence of drug therapies for chronic conditions often lowers the cost of total care by keeping patients out of the hospital, Prime found that the increase in uptake of multiple sclerosis therapies was not associated with a decrease in medical costs.

“As the results show, MS specialty drug costs have increased by double digits in the last several years and are not projected to level off in the near future,” said Pat Gleason, PharmD, FCCP, BCPS, director of clinical outcomes assessment at Prime, in a release.

Researchers of the report claim that inflationary price increases are the major driver of the cost increases, noting that for the past 5 years, MS specialty pharmaceutical manufacturers have had double-digit price increases annually. The anticipated medical cost savings from MS drugs cannot offset the cost of these therapies, as pharmacy costs now exceed all medical costs for this condition, according to the report.

The drugs included in the study were dalfampridine, fingolimod, glatiramer, interferon beta-1a and 1b, natalizumab, and mitoxantrone. Since 2008, the wholesale acquisition cost for beta-interferon has nearly doubled (81.1% to 92.8%), glatiramer has more than doubled (111.7%), and natalizumab has increased two-thirds (65.8%). The use of Ampyra (dalfampridine ) or Gilenya (fingolimod) in place of another MS agent, the researchers wrote, could increase the pharmacy portion of direct MS health costs to 70%. New medications slated to hit the market, like Biogen Idec’s BG-12 this December and laquinimod and Lemtrada (alemtuzumab) in 2013, are expected to further increase the pharmacy cost burden.

To solve this problem, the researchers suggested implementing measures to control price inflation. “As pharmacy benefit managers and health plans strive to improve the quality of care for individuals with MS through improved adherence, the expected increases in cost of care can be mitigated through rebate contractual relationships that provide some measure of price inflation protection,” they wrote.

Aubagio (teriflunomide), one of the newest market entrants, is priced lower than glatiramer and interferon beta-1a, and substantially less than Gilenya. Aubagio is cheaper than most established therapies, a fact which sources say will produce greater than anticipated adoption rates. In addition, Aubagio’s manufacturer is implementing a copay program that includes a 3-month free trial, with patients paying only $35 a month after the trial period ends. Some argue the price of Aubagio should be even lower than it is already, as Aubagio is the principal active metabolite of leflunomide (brand name Arava), a drug for rheumatoid arthritis that was approved in 1998 and has been available as a generic for quite some time.