TOPLINE:

Use of disease-modifying therapies (DMTs) for immune‑mediated neurologic disorders remained relatively stable between 2013 and 2022, accounting for just 2% of Medicare Part D claims. But related costs soared, contributing 41% to overall Medicare drug expenditures, even after adjusting for medical care and drug inflation, a new retrospective study showed. 

METHODOLOGY:

• Researchers conducted a retrospective economic evaluation using Medicare Part D Prescriber Public Use Files from 2013 to 2022. They analyzed more than 269 million claims for immune-mediated neurologic disorders, totaling $85.9 billion in expenditures.
• The analysis included neurology-taxonomy prescription claims for 63 unique DMTs (17 oral, 27 injectable, and 19 infusible) used in multiple sclerosis, neuromyelitis optica spectrum disorder, and other immune-mediated neurologic disorders.
• The primary outcomes were total annual DMT claims, total payments, and mean payment per claim, with payments adjusted for medical care and prescription drug inflation using a US Bureau of Labor Statistics database.
• A secondary analysis examined 10-year trends, excluding therapies introduced after 2013 or lacking consistent claims throughout the study period, route administration, and DMT class.

TAKEAWAY:

• The 63 DMTs accounted for 2% of claims but contributed to 41% of Medicare drug expenditures. From 2013 to 2022, DMT claims increased by 4%, whereas total payments for DMTs rose by 70% (P = .02). In 2022, mean payment per claim was up 29% (P = .003) after adjusting for medical care inflation and 36% (P < .001) after adjusting for prescription drug inflation.
• For 29 continuously available DMTs, claims decreased by 15% but total payments increased by 60.5% (P < .001). After adjusting for medical care inflation, payment increased by 26% (P = .007); it increased by 33% (P < .001) after adjusting for prescription drug inflation.
• Infusible DMT claims showed the largest growth at 264% (P < .001), whereas oral DMT claims declined by 55% (P < .001).
• Per‑claim payments generally increased across most DMT subclasses, with the cost burden shifting toward high‑cost infused biologics such as anti-CD-20 therapy (P = .03) and immunoglobulin therapy (P < .001).

IN PRACTICE:

“These findings underscore the disproportionate economic burden of DMTs, accounting for more than 40% of Medicare Part D spending on neurologic conditions, and highlight the need for continued cost monitoring and potential policy interventions, such as the Medicare Drug Price Negotiation Program, beyond manufacturer rebates,” the investigators wrote.

SOURCE:

The study was led by Ka-Ho Wong, University of Utah School of Medicine, Salt Lake City, Utah. It was published online on October 20 in JAMA Network Open.

LIMITATIONS:

The study was limited by its reliance on Medicare Part D data, representing a single-payer older population, which may not have fully reflected the trends among privately insured or younger patients. It also lacked clinical information on disease severity and treatment response. Additionally, manufacturer rebates and discounts were not captured, so actual net expenditures may have been lower than reported. These factors limited the generalizability of the findings.

DISCLOSURES:

Two investigators reported having financial or other ties with various sources, which are fully listed in the original article. The other investigators reported having no relevant financial relationships. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.