Drug competition didn’t stop sharp increase in MS spending

Between 2009 and 2015, spending on patients with multiple sclerosis (MS) greatly increased, with disease modifying therapies (DMTs) accounting for 82 percent of that increase as prices jumped every year and use slightly declined.

The report from the Health Care Cost Institute (HCCI) examined claims for people with MS from 2009 to 2015 covered by individual market, employer-sponsored or Medicare Advantage plans. It found total spending per MS patient rose from around $23,900 to $39,628 by 2015. During the same time period, the share of spending spent towards injectable and oral DMTs rose from 39 percent to 53 percent.

DMTs are believed to slow progression of MS and reduce the frequency and severity of attacks which can cause weakness, changes in vision and difficulties in coordination. Its injectable forms, such as Copaxone and Avonex, were the older method of treatment and began being challenged by newer oral DMTs: Gilenya (introduced in 2010), Aubagio (2012) and Tecifidera (2013).

Use of DMTs increased from 2012 to 2015 coinciding with the availability of those new oral treatments. They didn’t come cheap, as Tecifidera accounted in $4,706 in spending per MS patient in 2015. Unsurprisingly, the availability of new treatments caused use of the older injectable DMTs to decline—but spending on those drugs continued to go up. For example, while Copaxone saw its use decrease by 24 percent between 2009 and 2015, its spending increased from $3,634 per person to $6,163 over the same time frame, a nearly 70 percent jump. 

In other words, increased competition failed to lower drug prices for MS patients.

“This research highlights the challenges people with MS face in affordably accessing their life-changing medications,” Bari Talente, executive vice president of advocacy at the National MS Society, said in a press release. “HCCI’s research illustrates the impact that increases in the prices of MS disease-modifying therapies have on people living with MS and the health care market. We continue our call for all stakeholders to join together and find solutions so people with MS get the medication they need to live their best lives.”

The National MS Society has been tracking increases of DMTs since they were first introduced in 1993, with its data indicating pharmaceutical companies may be engaging in “shadow pricing,” a strategy to increase the price of older drugs to match that of new treatments. Copaxone, for example, cost $8,292 when it was first approved in 1997. By 2016, it cost $84,707, similar to the $81,135 price tag for Tecifidera which had been only been approved three years earlier (and itself had risen in price by more than $23,000 during that time).

Those trends have attracted some attention from Congress. In August 2017, Reps. Elijah Cummings, D-Maryland, and Peter Welch, D-Vermont, demanded pricing information on pharma companies producing DMTs, saying prices have jumped “without warning, cause, or justification.”