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Does competition equal lower prices? MS drugs defied cost logic as challengers swarmed in


The average price of MS therapies quadrupled between 2006 and 2016, according to a new study. (Pixabay)

Once only a small group of competitors, the field for multiple sclerosis (MS) therapies has exploded in recent years: By 2016, the number of approved drugs had nearly tripled in just seven years. That’s speedy growth, but something else grew faster—those drugs’ list prices.

The average price of self-administered disease-modifying therapies for MS quadrupled between 2006 and 2016 as a rush of competitors flooded the market, according to a new study published in JAMA Neurology.

That increase included therapies introduced prior to 2009, when only four were approved, to the seven new therapies introduced between 2009 and 2016, researchers from the University of Pittsburgh found. On the whole, the average price of those therapies rose from an annual cost of $18,660 to $75,847—an average annual jump of 12.8%.

The data is troubling news for officials who have argued that more competition equates to lower prices for consumers.

“One of the most significant findings was that the prices of these drugs have increased in parallel,” lead author Alvaro San-Juan-Rodriguez, Pharm.D, said in a statement. “Only a couple exceptions deviate from that general trend.” 

What’s more, the brunt of the field’s price increases has fallen squarely on Medicare Part D beneficiaries, researchers found.

Between 2006 and 2016, the out-of-pocket patient pending on MS drugs per 1,000 beneficiaries increased from $371 to $2,673—a more than sevenfold increase.

“We’re not talking about patients without health insurance here,” study senior author Inmaculada Hernandez said in a statement. “We’re talking about insured patients, under Medicare. Still, they are paying much more for multiple sclerosis drugs than they were 10 years ago.”  

The findings are nothing new for drug cost-effectiveness gatekeepers that have repeatedly knocked the field for its lack of cost effectiveness. Tellingly, new MS drugs approved after 2016—with eye-popping list prices of their own—have not escaped watchdogs’ ire.

Back in March 2017, U.S. watchdog the Institute for Clinical and Economic Review (ICER) said most of the MS field was “overpriced,” and gave only Sanofi’s Lemtrada a pass as cost-effective over supportive care.

That list of no-gos included standbys from Teva Pharmaceutical, Biogen and Bayer to newer oral meds from Biogen, Novartis and Sanofi, which makes Aubagio in addition to Lemtrada.

Since then, ICER’s tune—and that of its English counterpart, the National Institute for Health and Care Excellence (NICE)—on MS drugs has largely stayed the same.

In June, ICER refused to recommend to payers Novartis’ Mayzent, which the FDA green-lighted in March to treat secondary progressive MS with a list price of $88,500.  

The Novartis product “contributes substantial costs without providing a meaningful extension of life relative to best supportive care,” ICER said at the time. Even with ICER’s hesitancy, analysts believe the drug could still have blockbuster potential.

Back in September, Roche’s primary progressive MS therapy Ocrevus also received a “no” from NICE, which said Roche’s cost-effectiveness estimates were “far higher than those NICE normally considers an acceptable use of NHS resources.”

Roche called the news “devastating,” saying the drug filled an unmet need in the U.K. market.

Those ominous signs haven’t stopped drugmakers from continuing to pursue new opportunities in the MS field.

In June, the FDA accepted Celgene’s filing for relapsing MS candidate ozanimod, which Bristol-Myers Squibb—which announced a merger agreement with Celgene in January—has billed as a best-in-class drug in relapsing MS and a first-in-class remedy for inflammatory bowel disease.