Costs Are Still on the Rise for Commonly Prescribed Branded Neurologic Medications

Ensuring Access to Neurologic Care: Challenges and Opportunities

Neurologic disorders are prevalent in the United States, with an estimated 60% of Americans experiencing at least one neurologic condition. This volume of neurologic disease requires commensurate care. In this article, we review access to neurologic care and examine challenges and opportunities across several dimensions of access. Long wait times for neurologists and evidence that neurologists see only a fraction of certain neurologic conditions suggest issues with the availability of care; better triage of neurologists' expertise and employment of neurology advanced practice providers may improve the supply of neurologic care. Accessibility of neurologic care is hindered by regional inequities and urban/rural disparities, which may be attenuated through the use of telemedicine. High out-of-pocket costs and excessive pharmaceutical prices inhibit the affordability of neurologic care; these obstacles may be addressed with more appropriate test utilization and more effective drug price negotiation. Lastly, innovative care models facilitated by recent technological advances have the potential to profoundly expand access to neurologic care.

Cost Trends of New-To-Market Neurologic Medications: An Insurance Claims Database Analysis

BACKGROUND AND OBJECTIVES

Costs for neurologic medications have increased considerably in recent years. Since 2014, more than 30 neurologic medications have been approved by the US Food and Drug Administration (FDA) for neurologic conditions. This study aims to characterize recent trends in annual costs and aggregate spending from 2012 to 2021 for new-to-market (NTM) medications for 9 neurologic conditions.

METHODS

We used the Merative MarketScan commercial and Medicare supplemental databases to observe patients seen by a neurologist with neurologic diseases with newly FDA-approved medications from 2014 to 2021: amyotrophic lateral sclerosis (ALS), transthyretin amyloidosis (ATTR), Duchenne muscular dystrophy (DMD), Huntington disease (HD), myasthenia gravis (MG), migraine, orthostatic hypotension (OH), tardive dyskinesia (TD), and spinal muscular atrophy (SMA). Patients were included if they had ≥1 disease-related prescription medication fill from 2012 to 2021. NTM (medications approved from 2014 to 2021) and older evidence-based guideline-supported medications were observed annually. Outcomes examined were annual and aggregate out-of-pocket (OOP) and total medication costs.

RESULTS

We identified 2,687 unique individuals with ALS, 38 with ATTR, 69 with DMD, 884 with HD, 9,984 with MG, 441,099 with migraine, 4,723 with OH, 1,266 with TD, and 17 with SMA. The youngest population was DMD (mean = 25 years [SD = 7]), and the oldest was TD (mean = 66 years [SD = 14]). For DMD, the population was 99% male and for migraine, the population was 84% female, and the other conditions had more relatively even sex divides. Collectively, migraine medications had the largest increase in aggregate costs (1993%) and had a substantial increase in OOP costs on average by 234% ($86-$288). Eculizumab for MG was an extreme outlier, with OOP costs increasing by 4,099% ($413-$17,359) and aggregate OOP costs by 7,005% ($5,375-$381,894). OOP costs of edaravone ($304-$5,707) and deutetrabenazine ($670-$7,170) sharply increased by 1,775% and 971%, respectively.

DISCUSSION

NTM medications for neurologic conditions have substantial and increasing individual and societal costs, which was not observed for older generic medications. These data suggest a need for policies to limit the financial burden of NTM medications on patients with neurologic conditions.