Medicare Part D Payments for MS Medications Outpace Inflation

A retrospective analysis of Medicare Part D prescription claims from 2013 to 2017 reveals that neurologic medication payments, including those related to treatments for multiple sclerosis (MS)—in addition to Parkinson disease and epilepsy—jumped by 50.4% in just 5 years while claims rose by only 7.6%.

Adjusting for inflation revealed similar findings, in that there were 42.4% and 45% payment increases for brand name only (BNO) and brand name drugs with a generic equivalent (BNGE), respectively. In comparison, generic (GEN) payments saw a payment increase of just 0.6%.

“Previous research has shown that drugs prescribed for neurologic disease are the most expensive part of neurologic care for people on Medicare,” said lead study author Adam de Havenon, MD, University of Utah, Salt Lake City, in a statement. “Our study shows a dramatic increase in the prices of neurologic medications over 5 years and the increase remained large even after being adjusting for inflation.”

These findings, published today in Neurology, the medical journal of the American Academy of Neurology, build on previous research and help to clarify price trends regarding the costs of medications to treat neurological diseases—which accounted for the most expensive portion of neurologic care in 2013, the authors note.

This retrospective analysis, which culled data from Medicare Part D Prescriber Public Use Files, encompassed 520 drugs (GEN, 322; BNO, 61; BNGE, 137), for 90 million–plus claims and claim payments exceeding $26 billion.

Analyses also revealed:

• Neuroimmunology/MS drugs accounted for more than 50% of all payments but less than 5% of all claims.
• Per-claim payments for neuroimmunology/MS drugs jumped 47.0%, from $3337 to $4902.
• The 50.4% jump in annual total payments for neurologic medications equates to $6.09 billion in 2017, up from $4.05 billion in 2013.
• Overall GEN claims rose 7.4%: from 81.9% to 88.0%.
• Overall BNO claims rose 26.5%: from 4.9% to 6.2%.
• Overall BNGE claims decreased 56.3%: from 13.3% to 5.8%.
• Each year of the study had an average 12,511 prescribers.
• Total claims rose 7.6%: from 17.1 million to 18.4 million.
• Average claim payment rose 39.7%: from $237 to $331.
• The average payment-to-claim ratio, at 41.85, was highest for neuroimmunology, followed by a precipitous drop to 1.75 for movement disorder, 1.59 for epilepsy, 1.62 for cognitive, 0.84 for headache, 0.57 for neuromuscular, and 0.47 for vascular—indicating that vascular neurology drugs came in at an 80% cheaper price point per claim vs neuroimmunology drugs.

All claims analyzed had “neurology” as the provider taxonomy, and the drugs included in the final analysis had to be consistently present for 2013 through 2017. Those considered outliers were excluded from the final analysis when the “payment change was more than 4 interquartile ranges below or above the first and third quartiles.”

The primary outcomes were yearly drug payments; claim amounts; payment-to-claim ratio, “where a ratio of 1.0 is equivalent to an individual claim costing $100,” the authors stated; and claim payment (ie, total yearly payments divided by total yearly claims).

“Payment for identical neurologic brand name drugs in Medicare Part D has increased consistently and well above inflation from 2013-2017,” the authors wrote. “Unless this trend stabilizes or is reversed, these payments will place a higher burden on the Medicare budget, which accounted for 15% of total federal spending in 2018 and is projected to continue growing.”

Opportunities to make progress include CMS negotiating lower prices for certain medication classes and encouraging neurologists to prescribe generic drugs instead of their brand name counterparts by making them aware of the cost differentials between the two.

“The most effective solution would control the price of drugs,” the authors concluded.

Reference

de Havenon A, Delic A, Dehoney S, et al. Five-year trends in payments for neurologist-prescribed drugs in Medicare Part D. Neurology. Published online March 10, 2021. doi:10.1212/WNL.0000000000011712