Trends In Coverage For Disease-Modifying Therapies For Multiple Sclerosis In Medicare Part D

Health Aff (Millwood). 2019 Feb;38(2):303-312. doi: 10.1377/hlthaff.2018.05357.

Abstract

The high cost of multiple sclerosis (MS) disease-modifying therapies can negatively affect access for patients through increased payer restrictions and higher out-of-pocket spending. Our objective was to describe changes in pharmacy benefit coverage and cost-sharing amounts for MS disease-modifying therapies in the Medicare Part D program, using enrollment-weighted Prescription Drug Plan Formulary files for the period 2007-16. Among therapies available throughout the study period, the rate of prior authorization use increased from 61-66 percent of plans to 84-90 percent. The share of plans with at least one therapy available without limitations declined from 39 percent to 17 percent. The projected cumulative out-of-pocket spending for 2019 was $6,894. The therapy with the highest out-of-pocket spending was generic glatiramer acetate. Policy makers need to consider both access restrictions and a growing cost-sharing burden as potential consequences of high and rising drug prices for people with MS.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic / economics
  • Adjuvants, Immunologic / therapeutic use
  • Cost Sharing* / economics
  • Cost Sharing* / trends
  • Female
  • Glatiramer Acetate / economics
  • Glatiramer Acetate / therapeutic use
  • Health Expenditures / trends*
  • Humans
  • Insurance Coverage / statistics & numerical data
  • Insurance Coverage / trends
  • Male
  • Medicare Part D / statistics & numerical data*
  • Multiple Sclerosis / drug therapy*
  • Prescription Drugs* / economics
  • Prescription Drugs* / therapeutic use
  • United States

Substances

  • Adjuvants, Immunologic
  • Prescription Drugs
  • Glatiramer Acetate