Pharmacy costs for multiple sclerosis patients increase at a faster rate than medical costs

Apr 15 2011

Analysis of direct pharmacy and medical costs for patients with multiple sclerosis (MS) showed pharmacy costs are increasing at a slightly faster rate than medical costs, but new MS medications are expected to shift the majority of the direct health cost burden to pharmacy, according to a new study by Prime Therapeutics (Prime). The study will be presented at the Academy of Managed Care Pharmacy's 23rd Annual Meeting in Minneapolis, Minn.

Between 2006 and 2009, pharmacy costs increased at a compound annual growth rate (CAGR) of 8.8 percent, while medical costs increased at a CAGR of 7.5 percent. Pharmacy costs made up a relatively constant 57 to 59 percent of overall MS treatment costs during those years.

"Biologics for the treatment of MS cost more than $30,000 a year on average per patient," said Patrick Gleason, PharmD, Director of Clinical Outcomes Assessment for Prime. "The recent FDA approval of two new MS medications has the potential to further increase pharmacy costs. As new treatments enter the market, it will be important for insurers to understand how medical and pharmacy costs vary in order to forecast future treatment costs. Thoughtful pharmacy benefit designs can help patients adhere to medications that improve their health, ensuring the greatest health benefit for their dollars spent."

For the study, researchers reviewed medical and pharmacy claims data from 390,108 Blue Cross Blue Shield members who were continuously enrolled from 2006 to 2009. They identified 361 members with at least one MS medical claim along with a pharmacy claim for a biologic medicine used to treat MS (beta-interferon or glatiramer). Within that group, per member per year total costs in 2006 were $29,652 with 57.7 percent coming from pharmacy. In 2009, costs increased to $37,592 with 58.6 percent ($22,015) due to pharmacy costs. The study also found that the addition of dalfampridine (Ampyra®) for MS in half of the individuals, or use of fingolimod (Gilenya®) in place of another MS agent, could increase pharmacy costs to 70 percent of the total MS health cost.