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Medicare patients with multiple sclerosis bear the burden of rising drug prices

Price increases do indeed get passed down to patients, the authors found, and that can negatively impact access.

Jeff Lagasse, Associate Editor

Over the course of a decade, out-of-pocket costs for multiple sclerosis drugs rose more than sevenfold for Medicare Part D beneficiaries, according to a JAMA Neurology study published this week by researchers at the University of Pittsburgh.

Using Medicare claims data from 2006-2016, the researchers looked at trends in multiple sclerosis drug prices over time. Not only did they find steep increases in list prices -- the starting point before rebates, coupons or insurance kicks-in -- but also in the ultimate costs to both Medicare and its recipients.

The goal was to see how price increases in list prices correlated to increases in out-of-pocket spending. Price increases do indeed get passed down to patients, the authors found -- and that can negatively impact access.

WHAT'S THE IMPACT

Several drugs on the market reduce the frequency and severity of multiple sclerosis flare-ups, which can involve a variety of disabling neurological symptoms, such as vision loss, pain, fatigue and muscle weakness.

From 2006-2016, the annual list prices of these drugs more than quadrupled, ballooning from about $18,000 to nearly $76,000 per patient per year.

Some of the most popular drugs for treating multiple sclerosis are Copaxone, Tecfidera and Avonex. And despite increased market competition over time, prices have been rising steadily for nearly all of them. With a couple of exceptions, the prices of the drugs increased in parallel.

Although this trend among list prices is alarming on its own, critics have argued that since some of the cost is canceled out by manufacturer rebates and other kinds of discounts, rising list prices may not be translating into increased spending.

But since Medicare claims provide a detailed cost breakdown, the researchers were able to measure changes in what Medicare Part D beneficiaries actually paid out of pocket for multiple sclerosis drugs, as well as what Medicare itself paid.

What they found was that from 2006-2016, Medicare spending increased by more than tenfold, and the patients themselves saw more than a sevenfold increase in their share of the bill.

THE LARGER TREND

Medicaid Part D drug spending is skyrocketing -- presenting a huge problem for patients and providers alike.

The Trump Administration proposed last year to implement an international pricing index model for Medicare Part B. Under that proposal, private vendors would procure drugs, distribute them to physicians and hospitals, and take the responsibility of billing Medicare.

Instead of the current percentage-based add-on payment, physicians and hospitals would receive a set payment amount for storing and handling drugs that would not be tied to drug prices, removing the financial incentive to prescribe higher-cost drugs, according to the Department of Health and Human Services.

This model has met with resistance from some healthcare organizations which cite patient disruption and potential unforeseen consequences.

Medicare Part D accounts for 3.4 times greater Medicare spending compared to Part B.

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com