Abstract Details

Title Reducing Out-of-pocket Costs of Disease-modifying Therapies for Medicare Part D Beneficiaries with Multiple Sclerosis: A Call to Action for Neurologists

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (11:45 AM-12:45 PM)

Poster/Presentation
Number 1-004

Objective To estimate out-of-pocket (OOP) costs for disease-modifying therapies (DMTs) among Medicare Part D beneficiaries with multiple sclerosis (MS) under different scenarios.

Background Recent developments such as the passage of the Inflation Reduction Act (IRA) and availability of direct-to-consumer (DTC) pharmacies could lower OOP costs.

Design/Methods We estimated Part D OOP costs for brand-name DMTs under three scenarios: (i) in 2023 before IRA implementation, (ii) in 2025 after the IRA introduces a $2,000 annual OOP maximum, and (iii) in 2025 after the $2000 OOP maximum is combined with monthly payments via voluntary enrollment in the Medicare Prescription Payment Plan (MPPP). We also compared OOP costs for generic DMTs under the above three scenarios vs. direct cash purchase via DTC pharmacies.

Results In 2023, estimated annual OOP costs ranged from $6,275 to $8,992 for brand-name DMTs. Under the 2025 Part D benefit, all brand-name DMT users will reach the new annual OOP maximum, with the entire $2,000 frontloaded in January unless beneficiaries enroll in MPPP. Enrolling in MPPP could lead to monthly payments as low as $167 for DMTs (a reduction of over 90% in monthly OOP costs for January). Purchasing generics through DTC pharmacies may reduce costs for some but not all generic DMTs.

Conclusions For Medicare beneficiaries with MS, OOP costs for DMTs will decrease significantly beginning January 1, 2025 due to the IRA’s $2,000 OOP maximum. Beneficiaries who voluntarily enroll in the MPPP will also be able to spread OOP costs in monthly installments (as little as $167 per month). Direct cash purchase of some generic DMTs through DTC pharmacies instead of via the Part D benefit could also lower costs for Medicare beneficiaries. Neurologists have a critical role in ensuring Medicare beneficiaries are aware of the option to enroll in the MPPP and the possibility of filling generic DMTs via DTC pharmacies.

Authors/Disclosures
Salim Chahin, MD (Washington University School of Medicine, Neurology Dept.) PRESENTER	Dr. Chahin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Chahin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Chahin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutic . The institution of Dr. Chahin has received research support from National MS Society. The institution of Dr. Chahin has received research support from BMS.
Pengxiang Li, PhD	Dr. Li has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cobbs Creek Healthcare . Dr. Li has received personal compensation in the range of $100,000-$499,999 for serving as a Consultant for SKB Consulting Inc.
John K. Lin, MD	Dr. Lin has nothing to disclose.
Matthew Klebanoff, MD	The institution of Dr. Klebanoff has received research support from HRSA.
Riya Palkar	Miss Palkar has nothing to disclose.
Jalpa Doshi, PhD	Dr. Doshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Merck & Co., Inc. Dr. Doshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Janssen Global Services, LLC. Dr. Doshi has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Abbvie. Dr. Doshi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Acadia. The institution of Dr. Doshi has received research support from Janssen Scientific Affairs, LLC. The institution of Dr. Doshi has received research support from Merck & Co., Inc. The institution of Dr. Doshi has received research support from Spark Therapeutics.

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