One of the biggest shocks a newly diagnosed MS patient might encounter is not even the diagnosis itself, but rather the cost of disease modifying therapies (or DMTs). If given ONLY the suggested manufacturer's price, pre-insurance, one might swoon under the stress of how to pay for it. After all, the median household income in the US, as of September 2013, was reported to be around $51,000 annually.
Take a look at the following chart to see how prices compare for each of the DMTs available today.
Current Cash Prices for a One-Month Supply of MS Medication || Source: Healthline:
One-month supply when purchased from Walgreens or Walmart pharmacy (averaged)
KEY:
Name of Medication
(Manufacturer)
Dose + monthly price + annual price
Aubagio
(Genzyme)
Dose: 14MG (30).............................$4,757.19......annually = $57,086.28
Avonex
(Biogen Idec)
Dose: Prefill 30MCG/0.5ML Kit............$4,967.64......annually = $59,611.68
Betaseron
(Bayer)
Dose: 0.3MG INJ (14).......................$5,482.12......annually = $65,785.38
Copaxone
(Teva)
Dose: 20MG 1PK=30 INJ...................$5,753.71......annually = $69,044.46
Extavia (Bayer)
Dose: 0.3MG INJ (15).......................$5,010.23......annually = $60,122.70
Gilenya
(Novartis)
Dose: 0.5MG CAP (28)......................$5,081.19......annually = $60,974.22
Rebif
(Merck KGaA/Pfizer)
Dose: 44MCG/0.5SYG INJ (12)............$5,227.52......annually = $62,730.18
Tecfidera
(Biogen Idec)
Dose: 240 MG CAP (60).....................$5,229.55......annually = $62,754.60
Tysabri
(Biogen Idec)
Dose: 300MG/15 INJ.........................$5,524.06......annually = $66,288.66
What in the world can drug manufacturers be thinking, setting these prices this high?
It's difficult to get a straight answer on this from anyone in the industry, but it basically boils down to this:
Costs of development (research)
Market demand
Competition
Patent Life (pre-generic)
Making drugs is a business, after all, so most basic business principles, like supply and demand, apply here as well. Drug manufacturers don't set these prices randomly; the high cost of development and the eventuality of a patent expiration mean they need to recoup as much as they can up front before generics can come in and stimulate competition (which will also, eventually, drive prices down). But lower, more competitive generic prices are NOT going to happen for a while.
So what are MSers supposed to do to afford these extremely expensive medications? It depends upon their insurance coverage. Private insurers cover DMTs at various rates that may or may not be acceptable to some patients. How the Affordable Care Act will ultimately impact MSers is also up for debate. Potential out-of-pocket caps on prescriptions mean patients may have to pay much more (25 percent) of the expense of their drugs, which could means expenditures of $1200 a month or more for some, which is an unrealistic option for many families.
Fortunately, most every drug manufacturer has a prescription assistance program set up to keep the prices down for any who apply. They vary from company to company, but ultimately these plans do bring the costs down. For some, it's considerable: MSActiveSource, for instance, makes it possible for most patients to pay just $10 a month for Avonex, Tecfidera or Tysabri. Other programs are less generous or offer different kinds of option,s depending upon the patient's current insurance plans.
MSers can learn how to apply for prescription assistance for their DMTs and other MS-related medications (i.e. IV Solu-Medrol, Prozac, Botox, Provigil, Acthar Gel, Ditropan, and more) at this LINK at the Multiple Sclerosis Association of American (MSAA) website.
PS THIS JUST IN: A great summary article from MS advocate Stuart Schlossman at Stu's Views & M.S. News: MS Medication Financial Assistance Programs, if you need the most updated, thorough information in one website. (Thanks, Stu!)
