ST. PAUL, Minn. — One in four multiple sclerosis (MS) patients are declining to fill their prescriptions likely due to high out-of-pocket costs, according to new research conducted by pharmacy benefits manager Prime Therapeutics (Prime).
The study found that patients with an out-of-pocket expense greater than $250 were seven times more likely to decline to fill their prescription than patients with an out-of-pocket cost of $100 or less. The study concluded that this increase in the number of patients who decline to fill their MS specialty prescriptions and do not continue taking the necessary MS medications may adversely affect long term patient care.
According to the study, the majority of individuals had an out-of-pocket expense of $150 or less and their decline to fill rate was 5.8 percent. For individuals with an out-of-pocket expense of greater than $150 the decline to fill rate was 27.0 percent.
“Specialty pharmacy costs are rising and insurers are focusing on ways to best manage costs, including increasing out-of-pocket costs for members,” said Patrick Gleason, PharmD, FCCP, BCPS, lead author and Director of Clinical Outcomes Assessment at Prime Therapeutics. “Our research suggests members who pay high out-of-pocket costs are declining to fill their prescription. Patients who aren’t taking their medications face serious medical and health complications, which could result in substantial medical or hospitalization expenses for both the patient and health insurer. Health insurers should consider member cost and the impact it has on adherence when designing specialty pharmacy benefits. “
Multiple sclerosis specialty medications (Avonex(R), Rebif(R), Betaseron(R) or Copaxone(R)) have a typical average wholesale price of $2,500 per month supply, $30,000 annually. Due to the potential large member expense for this specialty drug class, Prime designed the study to examine whether an association existed between declining to fill and out-of-pocket expenses. The study considered a member as “declining to fill” whenever there was a reversed claim for a MS specialty medication and no paid claims for that medication during the following 90 days. The study looked at a database of seven million members from eight commercial Blue Cross and Blue Shield plans who presented a new MS medication prescription to be filled at the pharmacy.
Prime Therapeutics LLC is a pharmacy benefit management company dedicated to providing innovative, clinically-based, cost-effective pharmacy solutions for clients and members. Providing pharmacy benefit services nationwide to approximately 14.7 million covered lives, its client base includes Blue Cross and Blue Shield Plans, employer and union groups, and third-party administrators. Headquartered in St. Paul, Minn., Prime Therapeutics is collectively owned by 11 Blue Cross and Blue Shield Plans, subsidiaries or affiliates of those Plans. Learn more at www.primetherapeutics.com.