Medicare patients with multiple sclerosis face skyrocketing costs for treatment due to insurance regulations that force them to pay more out of pocket for generic drugs, a study has found.
The research, by Oregon Health & Science University, found that patients without low-income subsidies are likely to pay nearly $7,000 this year for life-saving drugs, mostly due to rules in their Medicare plans. According to the National Multiple Sclerosis Society, nearly 1 million Americans have multiple sclerosis.
The regulations stem from the 2018 Bipartisan Budget Act, federal legislation that lowered the cost of brand-name drugs for Medicare patients by 75 percent but ended up straddling those who use generics with higher out-of-pocket costs.
In one example, a generic medication for multiple sclerosis that helps reduce the risk of a relapse, glatiramer acetate, costs almost as much as brand-name alternatives, said Daniel Hartung, who co-authored the study. Hartung, an associate professor in the OHSU/Oregon State University College of Pharmacy, said that means that those who are prescribed generic drugs are actually paying more for treatment than those who are using brand name medications because the legislation didn’t apply the same discount to generics.
Hartung told The Lund Report the disparity between generic and brand name drug prices could narrow if the Trump Administration pushes through its American Patients First plan, a multi-pronged attack on out-of-pocket drug costs that seeks to improve competition and negotiation in the industry, and creates incentives for manufacturers to lower list prices.
The study also looked at pre-authorization requirements and their effect on multiple sclerosis patients. Insurance companies require patients to get pre-approval -- or prior authorization -- in certain cases as a way to manage access to treatments and hold down costs.
The researchers found that incidences of prior authorization for multiple sclerosis patients increased from 61 to 66 percent in 2007 to as much as 90 percent by 2016. In this same period, drug prices more than quadrupled, increasing by about 15 percent a year.
Those higher pre-authorization requirements can restrict access to drugs that multiple sclerosis patients might need for treatment, Hartung said. Guidelines from the American Academy of Neurology call for patients to have access to all therapies because of variations among patients. Different treatments depend o the patient’s progression and symptoms.
In restricting access to a range of drugs, patients can end up being forced to pay more out-of-pocket, Hartung said.
Have any tips about pharmaceutical costs in Oregon? Contact Alex Visser at [email protected].
