Neurologic Diseases

Out-of-pocket costs for drugs used to treat neurologic diseases including dementia and Parkinson’s disease (PD) have increased exponentially over the past 13 years with the most dramatic increase for multiple sclerosis (MS) medications, new research shows. Investigators found that average out-of-pocket costs for patients on MS drugs were 20 times higher in 2016 than they were in 2004.

Nationally representative data

The research is the first to evaluate nationally representative data from a private insurer; so focusing on major neurology conditions and out-of-pocket medication costs. Given the high costs of many neurologic medications; also the increasing cost sharing by patients; so the total cost burden carry by patients is likely increasing,” the researchers note. “Yet the magnitude of this burden is not well-quantified.

The investigators evaluate the five most commonly prescribe medications for each condition; so as well as some other high-cost treatments. The eight medications for MS include teriflunomide, peginterferon-β-1a, interferon-β-1b, interferon-β-1a (Rebif), interferon-β-1a (Avonex), glatiramer acetate, fingolimod, and dimethyl fumarate. They evaluate mean out-of-pocket costs and mean estimate total costs for a 30-day supply of each agent.

Similarly, monthly out-of-pocket and totals costs for many epilepsy agents topiramate, levetiracetam, lamotrigine, divalproic acid, and carbamazepine remain stable from 2010 to 2016. Carbamazepine was an exception, with rising costs between 2014 and 2016. Although total monthly costs for the anti epileptic drug lacosamide held steady since 2009; so the researchers found the proportion of costs paid by patients rose steadily since 2010.

Potential clinical implications

Total monthly costs for PD medications carbidopa-levodopa and amantadine remain low during the study years. The generic effect was observe with ropinirole and pramipexole; so with total costs dropping “precipitously” after 2007 and 2010, respectively, the researchers note. The total costs for rasagiline remain stably high throughout the study; so with out-of-pocket costs rising from 2014 to 2016.

Going forward, Callaghan plans to look at one of the potential clinical implications of increasing out-of-pocket medication costs. They are studying the impact of out-of-pocket costs on medication adherence in these neurologic conditions, he said. They have show in well design clinical trials and in practice to reduce the number of relapses that people experience, limit new inflammation and damage, and positively impact worsening.

“With more than 15 disease-modifying therapies on the market; so many with differing mechanisms of action and administration; so the decision on an appropriate and effective therapy rest with the MS provider; also the person living with MS,” she said However, out-of-pocket costs associate with these agents “have risen so much that access is not possible for many and this limits the choices that people have to best control their MS,” Costello added.