OBJECTIVES: Identify and compare national trends in ocrelizumab and natalizumab costs and site-of-service distribution over time.

METHODS: This retrospective, repeated cross-sectional study of US commercial claims, using PharMetrics Plus data from January 1, 2018-March 31, 2021, assessed quarterly trends in ocrelizumab and natalizumab real-world cost and site-of-service distribution. The number of ocrelizumab and natalizumab claims, identified using HCPCS or NDC, and mean total allowable cost per dose (in 2021 USD) were presented quarterly and by site-of-service.

RESULTS: Of 95,645 ocrelizumab and 189,784 natalizumab claims, 39% and 31% occurred in hospital outpatient departments (HOPD), 52% and 62% in offices, and 9% and 7% in other sites-of-service, respectively. The proportion of ocrelizumab claims occurring in HOPD from Q1 2018 to Q2 2022 decreased from 56% to 25%, while the proportion of claims occurring in offices and other sites-of-service increased from 39% to 63% and 5% to 13%, respectively. For natalizumab, HOPD decreased from 42% to 22%; however, offices and other settings increased from 53% to 69% and 6% to 9%, respectively.

Mean overall and HOPD ocrelizumab cost per dose decreased by 20.3% in Q1 2018 (from $44,350 to $35,357) and by 23% in Q2 2022 (from $55,261 to $42,612), respectively, while offices and other settings remained relatively unchanged. For natalizumab, overall and HOPD mean costs decreased from $8,242 to $7,620 (−7.5%) and from $10,373 to 10,061 (−3%), while offices and other sites-of-service increased from $6,702 to $6,915 (3.2%) and from $6,777 to $7,182 (6%), respectively.

CONCLUSIONS: While site-of-service distribution for both ocrelizumab and natalizumab has shifted away from higher-cost HOPD to lower-cost office and other sites-of-service, reductions in mean ocrelizumab costs were disproportionately higher than those for natalizumab over time. Real-world data can be leveraged to enable payers to make well-informed patient-access decisions for therapies while still supporting physician and patient choice.