OBJECTIVES

: Multiple Sclerosis (MS) is a rare, disabling disease that affects the central nervous system causing various clinical manifestations. We analyzed the trends in drug expenditure, utilization, and price of specialty drugs for multiple sclerosis in the U.S. Medicaid Program.

METHODS

: This was a retrospective drug utilization research analysis. The prescription data and reimbursement of MS Disease-Modifying Therapies (DMTs) were obtained from the CMS Medicaid State Drug Utilization Data from January 2008 to December 2018. Specialty drugs included dimethyl fumarate, fingolimod, teriflunomide, alemtuzumab, natalizumab, ocrelizumab, daclizumab, glatiramer acetate, peginterferonb1A, interferonb1A , and interferon b1B. Trends of the number of prescriptions, reimbursement expenditures and prices were calculated annually. The average reimbursement per prescription was calculated as an estimate of the drug price.

RESULTS

: Annual MS drug utilization increased from $85,209 in 2008 to $223,604 in 2016, then decreased to $194,877 in 2018. The annual reimbursement has surged by 633% in the last 10 years, from $172 million in 2008 to $1.4 billion in 2017, then to $1.26 billion in 2018. The price per prescription increased over time for most MS brand-name drugs, e.g., from $2,033 in 2008 to $5,114 in 2018 for natalizumab, and from $19,138 in 2016 to $23,588 in 2018 for alemtuzumab. In 2008, self-injectable drugs dominated the market. Recently between 2017- 2018, there has been a shift in the utilization and reimbursement of MS drugs where oral medications are becoming predominant.

CONCLUSIONS

: Increased utilization and spending trends of MS specialty medications are significant and sizable for the US Medicaid programs. Intermarket and interbrand competition among the MS specialty drugs were also observed. Medicaid policymakers should investigate new ways to contain further spikes in prescription prices in order to control budget burden on states and government.