OBJECTIVES: A population-based budget impact analysis (BIA) was developed to inform health care decision makers. This analysis estimated the budgetary impact of adding ponesimod to a formulary list by assessing the drug acquisition and administration costs of all disease modifying treatments (DMTs) for relapsing multiple sclerosis (RMS) currently on the market.

METHODS: An interactive BIA was developed in Microsoft Excel^® and captured a third-party payer perspective and 3-year time horizon. Impacts were calculated as cost differences between scenarios with and without ponesimod based on projection of trends observed in Symphony Health Solution data (2016-2019). For a health plan of 1 million members, the treatment-eligible population of patients with RMS was estimated to be 1,096 patients in 2021, 2022, and 2023. The projected share uptakes for ponesimod were 0.5%, 1.5%, and 2.5% for 2021, 2022, and 2023, respectively. The base-case assumption was that ponesimod capture shares proportionally weighted to other DMT shares. The number of patients on each DMT were calculated as the product of the treatment-eligible population size and DMT market shares. Results are reported as total annual, per patient per month (PMPM), and administration costs.

RESULTS: Given the projected uptake, adding ponesimod increased total annual costs from $96,270,677 to $96,386,964 in 2021; $97,687,596 to $97,942,891 in 2022; and $98,011,264 to $98,406,790 in 2023. These values translate to PMPM increases of $0.01 in 2021, $0.02 in 2022, and $0.03 in 2023. Drug acquisition costs accounted for the majority of total annual cost; administration costs only accounted for 0.14-0.17% of costs.

CONCLUSIONS: Because of high variability of the disease, patients with RMS require access to the full range of treatment options. The addition of ponesimod to a formulary list was estimated to have only a minimal impact on the annual budget of a commercial health plan.