MS Drug Pricing Wars: A Race to Break the Bank?
Drugs used to treat multiple sclerosis are expensive Patients know this, insurance companies know this, but are healthcare professionals just now realizing how much MS drugs have increased in price over the past two decades?
In a recent study published in the journal Neurology, researchers took a closer look at the escalation of disease-modifying therapy (DMT) drug prices over the last 20 years, since the first-generation treatments (Betaseron, Avonex, and Copaxone) were approved in 1993 and 1996. Researchers examined price increases following the approval of new MS drugs between 2002 and 2013 and compared changes in DMT costs to general and prescription drug inflation.
Drug prices then and now
When the first-generation DMTs first hit the MS market in the United States, the annual cost was approximately $8,292 to $11,532. The price for these medications increased 434-615 percent between launch and the end of 2013. The average annual cost for MS drugs is currently about $60,000 in the US.
With 12 FDA approved DMTs for MS, one might think that market pressures would result in lower drug prices. Not the case. As each new DMT was approved, the initial price was often 25%-60 percent higher than existing DMTs and overall prices typically caught up.
Average prices follow the leader
The rate of price increases of specialty drugs have outpaced those of traditional medications for years. For example, in 2014 the overall expense of specialty drugs increased 30.9 percent while traditional drugs increased 6.4 percent, according to the 2014 Express Scripts Drug Trend Report, published March 2015.
In the early years of MS drugs (1993-2002), prices remained stable. After Rebif was launched in 2002 with a price of $15,262, it took three years before the average price of MS drugs rose to $15,792 in 2005. Tysabri was relaunched in 2006 with a price tag of $25,850 after which it took about two years before the average price rose to $24,077.
2009 was the year that the overall cost of MS drugs increased a whopping 34.4 percent. After Extavia was launched at $32,826, it only took one year before the average price leveled to $32,625. The price of MS drugs had finally seemed to level out with little difference between the most and least expensive choices.
All hell breaks loose
When Gilenya was launched in September 2010, the patient community was outraged at the $50,775 price tag (or $48,000 depending on the source). It wasn’t long before the price of other MS drugs swiftly rose, closing the gap once again, as the overall expense of MS drugs increased 25.4 percent in 2010. However, the overall trend for MS drugs has slowed in recent years, even with the Aubagio ($47,651) and Tecfidera ($57,816) launches in 2012 and 2013, respectively.
Drug trends for MS drugs (by year)
- 2005: Cost increase 11.7 percent + Utilization 2 percent = Overall 13.7 percent; Average cost = $15,792
- 2006: Cost increase 15.1 percent + Utilization 3.4 percent = Overall 19 percent; Average cost = $17,639; Tysabri re-launch June 2006 at $25,850
- 2007: Cost increase 12.1 percent + Utilization 3.2 percent = Overall 15.7 percent; Average cost = $19,764
- 2008: Cost increase 21.9 percent + Utilization -2.9 percent = Overall 18.3 percent; Average cost = $24,077
- 2009: Cost increase 32.5 percent + Utilization 1.9 percent = Overall 34.4 percent; Average cost = $29,584; Extavia launch August 2009 at $32,826* 2010: Cost increase 29.4 percent + Utilization -3.9 percent = Overall 25.4 percent; Average cost = $32,625;** Gilenya launch September 2010 at $50,775**
- 2011: Cost increase 18.2 percent + Utilization 2.1 percent = Overall 20.3 percent; Average cost = $37,391
- 2012: Cost increase 17.3 percent + Utilization 0.5 percent = Overall 17.8 percent; Average cost = $43,006; Aubagio launch September 2012 at $47,651* 2013: Cost increase 14.7 percent + Utilization 1 percent = Overall 15.7 percent; Average cost = $49,647;** Tecfidera launch March 2013 at $57,816**
- 2014: Cost increase 9.7 percent + Utilization 3.2 percent = Overall 12.9 percent; Average cost = $54,121
“It is time for neurologists to begin a national conversation about unsustainable and suffocating drug costs for people with MS—otherwise we are failing our patients and society,” conclude study authors.
Of course, it is difficult to ascertain the exact prices of medications at various points in time as data is often proprietary. The above numbers were taken from the Neurology article and annual drug trend reports produced by Express Scripts (a large pharmacy benefit manager).
Data regarding Lemtrada, Plegridy, Novantrone, and the higher-dose Copaxone formulation were not included in the Neurology study. And, who knows at this point how the entrance of Glatopa (ie. generic Copaxone) will affect pricing in the MS market. We'll be following and will tune you in as soon as we have more information.
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Hartung DM, Bourdette DN, Ahmed SM, Whitham RH. The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail? Neurology® 2015;84:1–8.
Express Scripts Drug Trend reports. Accessed at http://lab.express-scripts.com/drug-trend-report