Have you checked the cost, recently, of MS drugs or of drug insurance premiums? Reuters, using data compiled by the health care research firm 3 Axis Advisors, has reported that price boosts were expected on more than 140 brands of drugs early this year – more than 500 if you include different doses and formulations. It’s probably not a coincidence that the monthly cost of my AARP Medicare Part D insurance, provided by United Healthcare, doubled starting in January.
People, like me, who live with multiple sclerosis are often treated with infusible therapies, such as Ocrevus (ocrelizumab), Tysabri (natalizumab), or Lemtrada (alemtuzuma), that tend to have the highest costs, according to an analysis of data from commercially insured patients in the U.S. reported in a April 2023 article in the Journal of Medical Economics.
“The overall healthcare costs for MS patients increased a lot after they initiated infusible DMTs [disease-modifying therapies],” the researchers wrote. Not only are those medications expensive, the cost of the infusion itself must be included in the total cost. For one DMT, this topped $179,000 for a year of treatment, according to this research.
A survey taken by KFF Health in 2022 said that 47% of those questioned reported it was very or somewhat difficult for them to afford their health care costs. For those without health insurance, 85% reported affording health care was difficult. Forty-one percent said they were living with some type of debt due to medical or dental bills due to the expense of their own or someone else’s care.
I don’t think the situation has improved much since then.
Cost: The unseen elephant in the examining room
On its website, the American College of Physicians (ACP) recommends that doctors talk about health care costs with patients. “You can help your patients by openly discussing treatment costs with them,” the website says. That sounds like a great idea to me, but patients need to start this conversation. That doesn’t happen very often. According to figures released in 2018 by the Centers for Disease Control, only about 20 percent of patients have asked their physician about prescribing a lower cost medication. I’ve been unable to find any statistics about the other side of that coin: the percent of health care professionals who have asked their patients about costs.
If you’re a health care professional, have you ever discussed the cost of a treatment with a patient before prescribing it or asked if the patient can afford it? Has a patient ever brought it up? It’s an elephant in the exam room that shouldn’t be avoided.
The ACP is concerned about “cost distress” and it suggests that all patients be asked one, or more, of these questions:
- Are you worried about your current financial situation because of your health care needs?
- Have you skipped appointments, tests, or medications because you could not pay for them?
- Are you worried about how your medical bills will be paid?
- Would you like to discuss the cost of your health care today?
If you have any of these concerns, and your doctor doesn’t raise the subject, start the discussion yourself. The doctor may know of sources of financial help or be able to prescribe a lower cost treatment. But you won’t know if you don’t ask.
(A version of this post first appeared as my column on the Rare Disease Advisor website.)
