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

Daniel M. Hartung, Kirbee A. Johnston, Adriane Irwin, Sheila Markwardt, Dennis Bourdette

Research output: Contribution to journalArticle

3 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)303-312
Number of pages10
JournalHealth affairs (Project Hope)
Volume38
Issue number2
DOIs
StatePublished - Feb 1 2019

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ASJC Scopus subject areas

  • Health Policy

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