A new study shows an "alarming rise" in the costs of drugs used to slow the progression of multiple sclerosis (MS) or reduce the frequency of attacks over the last 20 years.

Yet this increase occurred even as there was a substantial increase in the number of MS drugs in the marketplace, which would ordinarily lead to lower or stabilized costs for patients who use those drugs, especially for first-generation therapies.

The costs of MS drugs accelerated at rates 5X to 7X higher than prescription drug inflation and substantially higher than rates for drugs in a similar class between 1993 and 2013, the researchers report. Drug costs for several MS agents rose on average 20 to 30 percent per year over this time period. 

In response to mounting concerns about the affordability of drugs used to treat MS, researchers examined 20 years of drug pricing data for nine MS drug treatments beginning with the initially approved injectable medications, up through the approval of the newest oral drugs. They found that long-standing drugs, such as Betaseron™, Avonex™ and Copaxone™, originally costing $8,000 to $11,000, now cost approximately $60,000 per year - an average increase of 21 to 36 percent annually. Their cost acceleration corresponded with the approval of newer agents, including Gilenya™, Aubagio™, and Tecfidera™, which have increased 8 to 17 percent annually since their approval. During that same period, general and prescription drug inflation only increased 3 to 5 percent per year.

The study shows that U.S. prices for MS drugs were also out of step with costs in other developed countries. In comparing current U.S. costs for all MS drugs with estimates from the United Kingdom, Canada and Australia, researchers found that the costs of MS drugs in the U.S. market are two to three times higher. MS drug costs in those industrialized countries were often more than 70 percent lower than U.S. costs.

Researchers also examined the costs paid by the U.S. Department of Veterans Affairs (VA) because of its ability to negotiate discounts directly with manufacturers. Their analysis shows that on average costs for the VA were 36 percent less than those paid by Medicaid, including a nearly 80 percent discount for Betaseron™. This cost disparity suggests the sharp rise in U.S. prices is not the result of increases in manufacturing costs.

"This study confirms what many of us treating patients with MS had suspected: The pricing trajectories of MS drugs are unsustainable for our health care system and need to be addressed," said Dennis N. Bourdette, M.D., F.A.N.A., F.A.A.N., co-author of the study and chair of the Department of Neurology in the Oregon Health&Science University.

The lack of transparency within pharmaceutical pricing and purchasing, and the absence of a national health care system within the U.S. to negotiate prices directly with the pharmaceutical industry may have contributed to the soaring costs of these drugs, according to the researchers.

Article: "The Cost of Multiple Sclerosis Drugs in the U.S. and the Pharmaceutical Industry: Too big to fail?" was authored by Daniel M. Hartung, Pharm.D., M.P.H.; Dennis N. Bourdette, M.D., F.A.N.A., F.A.A.N.; Sharia Ahmed, M.P.H.; Ruth H. Whitham, M.D., F.A.A.N., Neurology