The cost of essential medications for multiple sclerosis have nearly tripled this decade, despite the release of the first generic MS drug, a new study shows.
The 2015 release of glatiramer acetate -- the generic version of Copaxone -- did nothing to halt skyrocketing prices for MS medications, said lead researcher Daniel Hartung. He's an associate professor of pharmacy with Oregon State University, in Portland.
"Overall, there were very minimal effects on the price of all the other medications in the class," Hartung said. "They continued to escalate at about the rate they had before."
Medicaid spending on 15 MS drugs increased from $453 million to just over $1.3 billion between 2011 and 2017, Hartung and his colleagues found.
Even after adjusting for average rebate amounts paid to the Medicaid program, spending still more than doubled from $278 million to $600 million per year, the data showed.
The spending increase can't be blamed solely on the expansion of Medicaid under the Affordable Care Act, either. The cost of MS drugs doubled from $2 per Medicaid enrollee to a little more than $4 per enrollee during the seven years of the study, Hartung said.
These drugs are essential for checking the progression of MS, a debilitating disease of the brain and spinal cord that affects nearly 1 million people in the United States, experts say.
According to Bari Talente, executive vice president of advocacy for the National Multiple Sclerosis Society, "The best thing people can do is to get on a disease-modifying treatment early, as soon as possible after their diagnosis, and stay on treatment continuously. Anything that interrupts treatment opens someone up to a relapse that they may not recover from."
Unfortunately, two of every five people living with MS have had to alter the use of their medications to cope with rising drug costs, according to a recent survey sponsored by the society.
"That can be anything from going with a medication that is not the one they prefer, to people skipping doses or delaying doses to make their prescription last longer," Talente said. "It opens that person up to potential detrimental effects."
Hopes that generic glatiramer acetate would help stem drug costs were dashed in part because of a strategy that pharmaceutical companies often employ to stay one step ahead, Hartung noted.
Prior to the release of the generic version, Copaxone manufacturer Teva Pharmaceuticals created a slightly different formulation of its branded drug and put it on the market, Hartung said.
The new formulation came in a 40 mg dose, as opposed to the earlier 20 mg dose that would be used by the generic version. This made the new Copaxone formula not interchangeable with the generic, he explained.
Between early 2014 and mid-2015, nearly half of Teva's market share was moved to the new 40 mg version, the researchers said.
"This is a tried-and-true strategy that branded drug companies will use to extend their franchise," Hartung said. "They'll release a slightly modified formulation or they'll tweak the molecule a little bit so it's virtually the same but technically not the same, so it can't be substituted."
It also didn't help that the generic drug launched at a price only 15 percent less expensive than the brand-name drug at the 20 mg dose and about the same price as the new 40 mg version, Hartung added.
As a result, "about two-thirds of glatiramer was still dispensed as the branded product at the end of 2017, which shows that even though there was a generic available, it didn't really penetrate the market very much," he said.
"That's probably one of the reasons why the availability of this generic had pretty minimal effects on the upward trajectory of the prices for the other drugs in the class," Hartung concluded.
Teva Pharmaceuticals did not respond to a request for comment, nor did the industry group PhRMA.
A second company introduced its own generic version of glatiramer acetate in October 2017 at an even lower price, making it the cheapest MS drug on the market, Hartung said.
Increased competition like this has long been hoped to curtail drug price increases, but it hasn't shaken out that way, Talente said.
"As more medications come to market, we see prices for almost all of the medications continue to increase," she noted. "Even with the introduction of the generics, we have not seen an overall shift in the impact on people with MS."
Hartung said, "It's an exceedingly complicated problem, and I don't think there's going to be one single solution. I think it will require some enhanced understanding of the complexity of the drug distribution channel, as well as some federal reforms that get at the heart of a market that's dysfunctional, that doesn't behave like a normal consumer market."
He pointed out that "some of these drugs have been around for 25 years, since the mid-1990s. They've escalated in price at the same rate as drugs that have come out in the last 10 years, and there's nothing different about those drugs. Nothing's been changed about how they're manufactured. In fact, manufacturing has probably gotten more efficient. It speaks to the failure of the marketplace to restrain pharmaceutical companies' ability to price these drugs to what the market can bear."
The new study was published online Jan. 15 in the journal Neurology.
The National MS Society has more about MS medications.
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