MS specialty drug treatment costs climb to two-thirds of total MS treatment cost

Multiple sclerosis (MS) specialty drug costs now account for more than two-thirds of MS patients’ total cost of care, according to a new study.

The study, by pharmacy benefit manager Prime Therapeutics, in collaboration with Blue Cross Blue Shield of Minnesota, found MS specialty drug costs, which are largely covered by the pharmacy benefit, have increased dramatically in the past several years and are not expected to plateau any time soon. In fact, Prime predicted that MS drug costs will exceed $50,000 per person per year in 2016.

While MS drugs have been shown to reduce relapses by approximately one-third, they have only minimally influenced progression of the disease and disability, according to a recent study published in the New England Journal of Medicine. Meanwhile, the costs continue to rise faster than traditional therapies. The price for MS self-injectable specialty drugs has increased 16.3% to 22.6% each year from 2008 to present. In addition, a 2009 study found the average annual total cost for treating MS among individuals utilizing a MS specialty drug was $37,592, of which 58.6% ($22,015) was the pharmacy cost. In 2010, the average total cost of care rose to $41,760; the MS specialty drug accounted for 67.4% ($28,152) of that total cost, almost all of which was covered by the pharmacy benefit.

“MS specialty drug costs are the fastest growing category within the total cost of MS care,” said Pat Gleason, PharmD, FCCP, BCPS, director of health outcomes at Prime. “These drugs are quickly becoming one of the largest pharmacy expenses among commercially insured members.”

The cost of these drugs is growing at 6.4 times the rate of all other medical costs, Dr Gleason explained. In 2011, MS drugs alone accounted for 3.6% of all pharmacy benefit costs across 9 million of Prime Therapeutics’ commercially insured members, amounting to an average per prescription cost of $3,135.

The annual double-digit price increases leveraged by MS specialty pharmaceutical manufacturers have now occurred for 5 consecutive years. If this trend continues, MS specialty drugs will soon be 75% of the total cost of MS care.

However, Dr Gleason noted that “the anticipated increases in the cost of care can be lessened through optimizing managed care tools such as formulary preferred products with utilization management, moving non-formulary specialty drugs to a fourth or fifth tier with a higher cost share, utilizing a specialty pharmacy network which provides better discounts and medication management services, and creating rebate contractual relationships that provide some level of price inflation protection.

“Pharmacy benefit managers and health plans also will continue to emphasize the importance of patient adherence to drugs, which not only will improve the quality of care but help eliminate the treatment relapses and lost productivity,” he added. ■