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LOS ANGELES – Under Medicare Part D, private prescription drug plans and those bundled with Medicare Advantage plans have steadily raised injectable and oral disease-modifying therapies for multiple sclerosis to higher tiers with higher cost sharing, reduced coverage of particular drugs, and increased prior authorizations during the 10-year period of 2007-2016, according to an analysis conducted by Oregon State University researchers.
At the annual meeting of the American Academy of Neurology, Daniel Hartung, PharmD, of Oregon Health and Science University, Portland, and his colleagues reported that the proportion of plans with disease-modifying therapies (DMTs) in the highest tiers, generally tier 5 and above, rose from 11% in 2007 to 95% in 2016.
The scope of drugs covered by the plans declined marginally. Over the 10-year period, plans covering at least three DMTs declined from 98% to 95%, but plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate declined from 85%-100% of plans to 60%-81%.
Plans with prior authorizations for DMTs rose across the board. The percentage of plans with at least one DMT not needing prior authorization dropped from 40% to 27%, while plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate rose from 62%-65% to 77%-80%.
Based on 2016 coverage characteristics, Dr. Hartung and his associates estimated that the expected annual out-of-pocket costs for patients in 2019 would be over $5,000 for all drugs in the analysis, after accounting for the Bipartisan Budget Act’s closing the Part D coverage gap in 2019.
Part D covers noninfusible DMTs, which in this analysis included glatiramer acetate 20 and 40 mg (Copaxone 20 and Copaxone 40), generic glatiramer acetate 20 mg (Glatopa), interferon beta-1a intramuscular (Avonex), interferon beta-1a subcutaneous (Rebif), interferon beta-1b (Extavia and Betaseron), peginterferon beta-1a (Plegridy), fingolimod (Gilenya), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera). The infusible drugs natalizumab (Tysabri), alemtuzumab (Lemtrada), and ocrelizumab (Ocrevus) fall under Medicare Part B.
The study was supported by the National Multiple Sclerosis Society. None of the authors had anything to disclose.
SOURCE: Hartung D et al. AAN 2018. Abstract P3.161
LOS ANGELES – Under Medicare Part D, private prescription drug plans and those bundled with Medicare Advantage plans have steadily raised injectable and oral disease-modifying therapies for multiple sclerosis to higher tiers with higher cost sharing, reduced coverage of particular drugs, and increased prior authorizations during the 10-year period of 2007-2016, according to an analysis conducted by Oregon State University researchers.
At the annual meeting of the American Academy of Neurology, Daniel Hartung, PharmD, of Oregon Health and Science University, Portland, and his colleagues reported that the proportion of plans with disease-modifying therapies (DMTs) in the highest tiers, generally tier 5 and above, rose from 11% in 2007 to 95% in 2016.
The scope of drugs covered by the plans declined marginally. Over the 10-year period, plans covering at least three DMTs declined from 98% to 95%, but plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate declined from 85%-100% of plans to 60%-81%.
Plans with prior authorizations for DMTs rose across the board. The percentage of plans with at least one DMT not needing prior authorization dropped from 40% to 27%, while plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate rose from 62%-65% to 77%-80%.
Based on 2016 coverage characteristics, Dr. Hartung and his associates estimated that the expected annual out-of-pocket costs for patients in 2019 would be over $5,000 for all drugs in the analysis, after accounting for the Bipartisan Budget Act’s closing the Part D coverage gap in 2019.
Part D covers noninfusible DMTs, which in this analysis included glatiramer acetate 20 and 40 mg (Copaxone 20 and Copaxone 40), generic glatiramer acetate 20 mg (Glatopa), interferon beta-1a intramuscular (Avonex), interferon beta-1a subcutaneous (Rebif), interferon beta-1b (Extavia and Betaseron), peginterferon beta-1a (Plegridy), fingolimod (Gilenya), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera). The infusible drugs natalizumab (Tysabri), alemtuzumab (Lemtrada), and ocrelizumab (Ocrevus) fall under Medicare Part B.
The study was supported by the National Multiple Sclerosis Society. None of the authors had anything to disclose.
SOURCE: Hartung D et al. AAN 2018. Abstract P3.161
LOS ANGELES – Under Medicare Part D, private prescription drug plans and those bundled with Medicare Advantage plans have steadily raised injectable and oral disease-modifying therapies for multiple sclerosis to higher tiers with higher cost sharing, reduced coverage of particular drugs, and increased prior authorizations during the 10-year period of 2007-2016, according to an analysis conducted by Oregon State University researchers.
At the annual meeting of the American Academy of Neurology, Daniel Hartung, PharmD, of Oregon Health and Science University, Portland, and his colleagues reported that the proportion of plans with disease-modifying therapies (DMTs) in the highest tiers, generally tier 5 and above, rose from 11% in 2007 to 95% in 2016.
The scope of drugs covered by the plans declined marginally. Over the 10-year period, plans covering at least three DMTs declined from 98% to 95%, but plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate declined from 85%-100% of plans to 60%-81%.
Plans with prior authorizations for DMTs rose across the board. The percentage of plans with at least one DMT not needing prior authorization dropped from 40% to 27%, while plans that covered interferon beta-1b, intramuscular or subcutaneous interferon beta-1a, or glatiramer acetate rose from 62%-65% to 77%-80%.
Based on 2016 coverage characteristics, Dr. Hartung and his associates estimated that the expected annual out-of-pocket costs for patients in 2019 would be over $5,000 for all drugs in the analysis, after accounting for the Bipartisan Budget Act’s closing the Part D coverage gap in 2019.
Part D covers noninfusible DMTs, which in this analysis included glatiramer acetate 20 and 40 mg (Copaxone 20 and Copaxone 40), generic glatiramer acetate 20 mg (Glatopa), interferon beta-1a intramuscular (Avonex), interferon beta-1a subcutaneous (Rebif), interferon beta-1b (Extavia and Betaseron), peginterferon beta-1a (Plegridy), fingolimod (Gilenya), teriflunomide (Aubagio), and dimethyl fumarate (Tecfidera). The infusible drugs natalizumab (Tysabri), alemtuzumab (Lemtrada), and ocrelizumab (Ocrevus) fall under Medicare Part B.
The study was supported by the National Multiple Sclerosis Society. None of the authors had anything to disclose.
SOURCE: Hartung D et al. AAN 2018. Abstract P3.161
REPORTING FROM AAN 2018
