title: The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail?
abstract: OBJECTIVE
  To examine the pricing trajectories in the United States of disease-modifying therapies (DMT) for multiple sclerosis (MS) over the last 20 years and assess the influences on rising prices.
  
  
  METHODS
  We estimated the trend in annual drug costs for 9 DMTs using published drug pricing data from 1993 to 2013. We compared changes in DMT costs to general and prescription drug inflation during the same period. We also compared the cost trajectories for first-generation MS DMTs interferon (IFN)-β-1b, IFN-β-1a IM, and glatiramer acetate with contemporaneously approved biologic tumor necrosis factor (TNF) inhibitors.
  
  
  RESULTS
  First-generation DMTs, originally costing $8,000 to $11,000, now cost about $60,000 per year. Costs for these agents have increased annually at rates 5 to 7 times higher than prescription drug inflation. Newer DMTs commonly entered the market with a cost 25%-60% higher than existing DMTs. Significant increases in the cost trajectory of the first-generation DMTs occurred following the Food and Drug Administration approvals of IFN-β-1a SC (2002) and natalizumab (reintroduced 2006) and remained high following introduction of fingolimod (2010). Similar changes did not occur with TNF inhibitor biologics during these time intervals. DMT costs in the United States currently are 2 to 3 times higher than in other comparable countries.
  
  
  CONCLUSIONS
  MS DMT costs have accelerated at rates well beyond inflation and substantially above rates observed for drugs in a similar biologic class. There is an urgent need for clinicians, payers, and manufacturers in the United States to confront the soaring costs of DMTs.
authors.affiliation: From the College of Pharmacy (D.M.H., S.M.A.), Oregon State University/Oregon Health & Science University; and the Department of Neurology (D.N.B., R.H.W.), Oregon Health & Science University, Multiple Sclerosis Center of Excellence West, Veterans Affairs Medical Center, Portland. hartungd@ohsu.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Hartung
authors.affiliation: From the College of Pharmacy (D.M.H., S.M.A.), Oregon State University/Oregon Health & Science University; and the Department of Neurology (D.N.B., R.H.W.), Oregon Health & Science University, Multiple Sclerosis Center of Excellence West, Veterans Affairs Medical Center, Portland.
authors.forename: Dennis N
authors.initials: DN
authors.lastname: Bourdette
authors.affiliation: From the College of Pharmacy (D.M.H., S.M.A.), Oregon State University/Oregon Health & Science University; and the Department of Neurology (D.N.B., R.H.W.), Oregon Health & Science University, Multiple Sclerosis Center of Excellence West, Veterans Affairs Medical Center, Portland.
authors.forename: Sharia M
authors.initials: SM
authors.lastname: Ahmed
authors.affiliation: From the College of Pharmacy (D.M.H., S.M.A.), Oregon State University/Oregon Health & Science University; and the Department of Neurology (D.N.B., R.H.W.), Oregon Health & Science University, Multiple Sclerosis Center of Excellence West, Veterans Affairs Medical Center, Portland.
authors.forename: Ruth H
authors.initials: RH
authors.lastname: Whitham
mesh_terms: D003365:Costs and Cost Analysis; D004345:Drug Industry / Q000191:economics*; D006801:Humans; D007155:Immunologic Factors / Q000191:economics*; D007166:Immunosuppressive Agents / Q000191:economics*; D009103:Multiple Sclerosis / Q000188:drug therapy* / Q000191:economics*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000191:economics*; D014481:United States
chemical_list: D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha