Out-of-Pocket Costs for MS Medications Rise While They Drop for Other Neurologic Conditions

Since the approval of the first disease-modifying therapy (DMT) for multiple sclerosis (MS) thirty years ago, the landscape for the treatment of this chronic inflammatory disease has changed significantly. Clinical guidelines now recommend starting DMTs soon after diagnosis to slow disease progression and disability accumulation and curtail neuronal damage caused by inflammation.

The catch: High costs of these treatments can hinder access to care and even interrupt treatment plans for some people living with M.S.

A recent study led by Amanda V. Gusovsky, Ph.D., M.P.H., and her colleagues from Ohio State University, Michigan State University, and the University of Michigan compared annual out-of-pocket costs and total medication costs for patients receiving treatment for MS or four other neurologic conditions. The results were published in the November 2024 issue of Neurology but had been previously published online in October 2024

The research team used data from a commercial insurance claims database to identify 516,717 patients treated by neurologists from 2012 to 2021. These included 54,676 patients with MS, 186,144 with epilepsy, 45,909 with Parkinson’s disease, 169,127 with peripheral neuropathy, and 60,861 with dementia/Alzheimer’s disease.

The study included participants who received a self-administered neurologic treatment covered by the pharmacy benefit up to 12 months after diagnosis.

The results showed an average out-of-pocket cost increase for MS DMTs of 217%, going from $750 per year in 2012 to $2,378 per year in 2021. This was the most significant increase observed among all the diseases analyzed. Annual out-of-pocket costs for generic medications for the other neurologic conditions decreased by 48% to 80%.

These cost decreases reflected the introduction of the generic medications duloxetine, pregabalin, rasagiline, rivastigmine, and memantine. On the other hand, the approval of glatiramer acetate, the generic version of Copaxone, did not result in out-of-pocket savings for patients with MS. Copaxone is an injectable DMT approved to treat relapsing forms of MS.

These results underscore the importance of including generics and biosimilars in formularies to reduce patient out-of-pocket costs. Just as essential is the clinicians’ willingness to prescribe generic and biosimilar treatment options. For MS treatments, where costs continue to rise, Gusovsky and her colleagues propose policy changes that would cap costs for MS DMTs.