The rising cost of prescription drugs to treat multiple sclerosis in upstate New York

Transcription

1 T H E F A C T S A B O U T The rising cost of prescription drugs to treat multiple sclerosis in upstate New York Per-person mean annual prescription drug cost to treat multiple sclerosis Annual drug cost $40,000 $35,000 $30,000 $25,000 $20,000 $15, % $16, % $18, % $21, % $25, % $32,200 $36,900 Franklin Clinton $10,000 St. Lawrence $5,000 Jefferson Essex $ Lewis Hamilton Oswego Niagara Orleans Monroe Wayne Oneida Herkimer Fulton Erie Genesee Wyoming Livingston Ontario Yates Seneca Cayuga Onondaga Cortland Madison Otsego Montgomery Schuyler Tompkins Chenango Chautauqua Cattaraugus Allegany Steuben Chemung Tioga Broome Delaware In 2010, approximately 13,000 upstate New York residents were living with multiple sclerosis. Of that number, about 7,000 took prescription medications costing an estimated $258 million altogether to treat their conditions in The disease-modifying prescription drug therapies that have been used to treat multiple sclerosis for the past few years have not changed. Even so, the total cost of prescription drugs used to treat multiple sclerosis has d during that time period. In 2005, the per-person mean annual prescription drug cost to treat multiple sclerosis was $16,300. By 2010, that number had d percent $20,600 to a total of $36,900. The drug cost s for multiple sclerosis treatments alone have added an additional $144 million to annual health care spending across upstate New York since Cost estimate is based on actual drug utilization among FLRx members in upstate New York and extrapolated to the 39 counties served by Excellus BlueCross BlueShield in the upstate New York area shown in the map above. FLRx is the pharmacy benefits management division of Excellus BlueCross BlueShield. FLRx manages prescription benefit services for approximately 1 million of the 4.9 million people who live in upstate New York's 39-county region CC 1 of 5

2 What is multiple sclerosis? Multiple sclerosis is a chronic, often disabling disorder of the central nervous system involving the brain, spinal cord and optic nerves. The disorder causes the myelin sheath (the protective fatty, insulating substance that covers the nerve) and sometimes the underlying nerve cells to be destroyed. Inflammatory attacks of the myelin sheath occur randomly and vary in intensity and location. Symptoms can be mild such as numbness in the limbs or severe such as paralysis or loss of vision. The progress, severity and specific symptoms of multiple sclerosis are unpredictable and vary from person to person. The course of the disease may advance, relapse, remit or stabilize, and it can affect the ability of nerves to transmit information and cause a variety of neurological symptoms. Most people who develop multiple sclerosis learn to cope with the disease and continue to lead satisfying, productive lives. Who gets multiple sclerosis and when is it diagnosed? Anyone can develop multiple sclerosis, but women are more likely to develop it than men, and it s more common among Caucasians of northern European ancestry than other groups. Usually, people are diagnosed between the ages of 20 and 50. Multiple sclerosis is not contagious and is not directly inherited. In the 39-county area of upstate New York included in this study and shown in the map on page 1, an estimated 13,000 people were living with multiple sclerosis in What medications/treatments are available? Although there is no cure for multiple sclerosis, medications approved by the Food and Drug Administration can modify or decelerate its course. Many therapeutic and technological advances also help people manage symptoms. The National Multiple Sclerosis Society recommends treatment with one of the FDA-approved, disease-modifying therapies as soon as possible following a definite diagnosis of active, relapsing multiple sclerosis, and sometimes even when a person is at high risk for developing the disease. Medications can help lessen the frequency and severity of multiple sclerosis attacks, reduce damage in the brain and slow disease progression. Of the estimated 13,000 people living with multiple sclerosis in upstate New York, approximately 7,000 took prescription drugs to treat the disease in of 5

3 FDA-approved, disease-modifying, immunomodulating drugs used to treat multiple sclerosis and their cost Six prescription drugs are FDA-approved, disease-modifying, immunomodulating drugs used to treat multiple sclerosis. Avonex, Betaseron, Copaxone, Extavia and Rebif are self-injectable drugs for long-term use. Tysabri is delivered by intravenous infusion at a registered infusion facility. These six prescription drugs have been used by multiple sclerosis patients for years. Added together, the drugs taken to treat multiple sclerosis in upstate New York cost $258 million in The table below shows the average wholesale price for 13 fills (52 weeks worth) of each medication. Drug 52-week Average Wholesale Price per MediSpan pricing on September 28, 2010 Avonex 30mcg $42,490 Betaseron 0.3 $44,750 Copaxone 20mg $47,190 Extavia 0.3mg $41,440 Rebif.22 or.44 $40,590 Tysabri 300mg $47,990 A retrospective look at the average wholesale price of each of these disease-modifying medications reveals dramatic price s over the past five years. The following two charts show the price s for just two of the drugs used to treat multiple sclerosis. Manufacturer Price Increases of Multiple Sclerosis Drugs: Avonex (Interferon-beta1a), Biogen Idec Date 52-week Average $ Increase from Percent Number of Price Wholesale Price Previous Year Increase Increases in One Year July 1, 2006 $22,650 July 1, 2007 $23,780 $1,130 5% 3 July 1, 2008 $31,370 $7,590 32% 2 July 1, 2009 $37,410 $6,040 19% 2 July 1, 2010 $40,650 $3,240 9% 2 Copaxone (Glatiramer injection), Teva Neuroscience, Inc. Date 52-week Average $ Increase from Percent Number of Price Wholesale Price Previous Year Increase Increases in One Year July 1, 2006 $22,300 2 July 1, 2007 $25,500 $3,200 14% 2 July 1, 2008 $30,600 $5,100 20% 3 July 1, 2009 $40,700 $10,100 33% 2 July 1, 2010 $47,200 $6,500 16% 2 From 2006 to 2010, the average wholesale price of Avonex d $18,000 (79 percent), while there was close to a $25,000 (112 percent) in the average wholesale price of Copaxone. 2 Cost estimate is based on actual drug utilization among FLRx members in upstate New York and extrapolated to the 39 counties served by Excellus BlueCross BlueShield in the upstate New York area. FLRx is the pharmacy benefits management division of Excellus BlueCross BlueShield. FLRx manages prescription benefit services for approximately 1 million of the 4.9 million people who live in upstate New York's 39-county region. 3 of 5

4 Impact of manufacturer price s on the annual drug cost for patients being treated with medication for multiple sclerosis Year Mean annual drug cost Percent in cost per person from previous year 2005 $16, $18, % 2007 $21, % 2008 $25, % 2009 $32, % 2010 $36, % Total $20, % The five-year period from 2005 to 2010 saw a $20,600 (or percent) in per-person drug costs to treat multiple sclerosis. If we take the estimated 7,000 upstate New Yorkers who used these multiple sclerosis medications to treat the disease in 2010 and multiply that by the $20,600 in drug costs over the past five years to treat each person s condition, these drug cost s alone have added an additional $144 million to annual health care spending across upstate New York. Based on the mean (50 percent) cost of drugs per person as determined by costs in the first half (January through June) of each year. Drugs include those that are self-injectable and those that are infused by a medical doctor. Assessment was made on 1,400 to 1,500 multiple sclerosis patients drug cost experience through FLRx for each year. 3 The mean cost represents the actual utilization costs for multiple sclerosis drugs used by multiple sclerosis patients over the course of a year as determined by claims history. These costs are different than the stated average wholesale price cost for 52 weeks of therapy because they represent the reality of medication refill compliance (getting all of the medication on time) and variations in patient drug use. 3 FLRx is the pharmacy benefits management division of Excellus BlueCross BlueShield. FLRx manages prescription benefit services for approximately 1 million of the 4.9 million people who live in upstate New York's 39-county region. 4 of 5

5 Newly approved prescription drugs to treat multiple sclerosis Although six drugs have dominated the prescription drug category for multiple sclerosis, two new prescription drugs to treat multiple sclerosis symptoms recently were approved for use by the FDA. Ampyra, a new oral drug for use as an adjunct to improve the quality of/speed of walking in multiple sclerosis patients, was approved by the FDA in January 2010 and became available in March. The average wholesale price is about $16,000 per year. Gilenya, the first oral drug to prevent relapses, was approved by the FDA in September 2010 and reached the market in October It is used to treat relapsing forms of multiple sclerosis. Its average wholesale price is expected to be more than $57,000 per year. Drug Food and Drug Administration Benefits 52-week Average Approval Date Wholesale Price Ampyra January 2010 Improves the quality of/ $16,470 speed of walking Gilenya September 2010 Prevents relapses $57,540 The development and FDA approval of these two, new prescription drugs to treat symptoms of multiple sclerosis means that: Ampyra would be an additional drug that could be added to the prescription drug regimen that multiple sclerosis patients already take. From a cost impact perspective, this would add an additional $16,000 to the $37,000 in drug costs for existing drugs. Gilenya may be substituted for one of the other drugs used by multiple sclerosis patients. If Gilenya is substituted for the most commonly used Avonex or Copaxone, Gilenya s higher cost would add $10,000 to $15,000 a year to treatment costs. An additional two to three oral drugs are awaiting FDA approval in of 5