Costs of Common Neurologic Meds Continue to Rise

In the United States, out-of-pocket (OOP) costs of brand-name medications for neurological disorders increased significantly from 2012 to 2021, with the largest hikes in multiple sclerosis (MS) drugs, new analysis shows. 

After adjusting for inflation, the analysis shows OOP costs for MS medications increased by 217%, from $750 per year in 2012 to $2378 per year in 2021.

In general, once generic versions of various medications became available, patient costs decreased, but the OOP cost of glatiramer, a generic MS medication introduced in 2015, increased, even though the total cost of the medication dropped.

“What we’re seeing is an increased and disproportionate burden of these costs to the patients, but not to the system at large,” study author Amanda Gusovsky, PhD, MPH, of Ohio State University in Columbus, told Medscape Medical News. 

She added that OOP costs for MS drugs have steadily increased over the past 20 years, suggesting that current efforts to control these rising costs for MS medications have not been very effective.

The findings were published online on October 30 in Neurology. 

Increase in Epilepsy Drug Prices

Previous research shows that few patients are able to access cutting-edge drugs for neurological conditions. A position statement issued by the American Academy of Neurology (AAN) in February calls for the implementation of multiple cost-reduction strategies to ensure that effective prescription medications remain accessible to patients with complex neurological conditions.

These include proposals that enable federal agencies to negotiate contracts with manufacturers of covered Part D drugs, and brand-name drug prices covered under Medicare such as those outlined in the Inflation Reduction Act of 2022. However, Gusovsky noted that per the law’s stipulations, prices won’t start to drop until after 2026.

To learn more about cost trends in prescription medications for neurologic conditions, the investigators used data from two nationally representative US claims databases covering the period 2012-2021 which included over 250 million privately insured individuals aged up to 64 years and older individuals enrolled in Medicare with an employer-sponsored Medigap plan. 

Investigators calculated annual OOP and total medication costs for five common neurological diseases. These included 186,144 people with epilepsy, 169,127 with peripheral neuropathy (PN), 60,861 with Alzheimer’s or other dementias, 54,676 with MS, and 45,909 with Parkinson’s disease (PD).

The analysis showed OOP costs for epilepsy drugs carbamazepine, lamotrigine, levetiracetam, topiramate, and valproate remained stable However, lacosamide, brivaracetam, and cenobamate all had higher and rising OOP costs. For lacosamide OOP costs increased from $279 in 2012 to $468 in 2021, reflecting a pattern of price hikes that began in 2010.

For PD, OOP costs for amantadine, pramipexole, and ropinirole remained stable over time. However, carbidopa-levodopa OOP costs increased by 100%, rising from $89 in 2015 to $177 in 2021. Rasagiline’s OOP costs peaked in 2014 at $353 and decreased by almost half when the generic version was introduced in 2017. 

OOP costs for the PN medication duloxetine dropped by 80% from an average of $231 in 2012 to $46 in 2021 after the generic version was introduced in 2013. Similarly, OOP costs for pregabalin decreased by 73% — from $204 in 2012 to $56 in 2020 after the introduction of the generic version in 2019. 

The introduction of generic Alzheimer’s and other dementia medications also resulted in a drop in OOP costs. Memantine prices peaked at $302 in 2014, but with the introduction of a generic version in 2015, they dropped by 78%, reaching $67 by 2021. 

Similarly, rivastigmine OOP costs decreased by 68%. OOP costs peaked at $248 in 2014, dropping to $80 in 2021. Rivastigmine generic capsules were introduced in 2010 and a generic patch in 2015.

The investigators noted that overall trends in total costs largely mirrored those of OOP costs, with few exceptions. Total costs for MS medications rose by an average of 80% over the study period, though they began to level off for some drugs toward 2021. Glatiramer saw a moderate decline in total costs from 2017 to 2021, while rasagiline peaked in 2016 at $6064 and subsequently decreased to $1798 by 2021.

Cost-Reduction Strategies

Several drug cost–reduction strategies are already underway, said Bruce H. Cohen, MD, chair of the AAN Advocacy Committee.

“In September, the Centers for Medicare and Medicaid Services announced the negotiated prices for the first ten Medicare Part D medications selected for the Medicare Drug Price Negotiation Program,” Cohen told Medscape Medical News, noting that empowering Medicare to negotiate prices directly for the first time is a major accomplishment. 

He also endorsed the use of generic medications and biosimilars where available, the development of novel therapeutics, and more transparency in the drug pricing process. 

Gusovsky pointed out that certain brand-name medications hold patent protection for as long as 20 years and suggested that revisiting patent protection policies could help improve access to neurologic medications for more patients in need. 

There was no targeted study funding. Gusovsky and Cohen reported no relevant financial relationships.