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Medicare Patients With MS Face Higher Out-of-Pocket Rx Costs

Last Updated: February 14, 2019.

Medicare patients with multiple sclerosis face increasing out-of-pocket costs for disease-modifying therapies, according to a study published in the February issue of Health Affairs.

THURSDAY, Feb. 14, 2019 (HealthDay News) -- Medicare patients with multiple sclerosis (MS) face increasing out-of-pocket costs for disease-modifying therapies, according to a study published in the February issue of Health Affairs.

Daniel M. Hartung, Pharm.D., M.P.H., from Oregon State University/Oregon Health and Science University in Portland, and colleagues used enrollment-weighted Prescription Drug Plan Formulary files (2007 to 2016) to assess changes in pharmacy benefit coverage and cost-sharing amounts for MS disease-modifying therapies in the Medicare Part D program.

The researchers found that the rate of prior authorization use increased from 61 to 66 percent of plans to 84 to 90 percent. There was a decline from 39 to 17 percent in the share of plans with at least one therapy available without limitations. For 2019, the projected cumulative out-of-pocket spending was $6,894. Generic glatiramer acetate was the therapy with the highest out-of-pocket spending.

"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," the authors write.

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