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Abstract
Background and Objectives The objective of this study was to compare the utilization and costs (total and out-of-pocket) of new-to-market neurologic medications with existing guideline-supported neurologic medications over time.
Methods We used a healthcare pharmaceutical claims database (from 2001 to 2019) to identify patients with both a diagnosis of 1 of 11 separate neurologic conditions and either a new-to-market medication or an existing guideline-supported medication for that condition. Neurologic conditions included orthostatic hypotension, spinal muscular atrophy, Duchenne disease, Parkinson disease, multiple sclerosis, amyotrophic lateral sclerosis, myasthenia gravis, Huntington disease, tardive dyskinesia, transthyretin amyloidosis, and migraine. New-to-market medications were defined as all neurologic medications approved by the US Food and Drug Administration (FDA) between 2014 and 2018. In each year, we determined the median out-of-pocket and standardized total costs for a 30-day supply of each medication. We also measured the proportion of patients receiving new-to-market medications compared with all medications specific for the relevant condition.
Results We found that the utilization of most new-to-market medications was small (<20% in all but 1 condition), compared with existing, guideline-supported medications. The out-of-pocket and standardized total costs were substantially larger for new-to-market medications. The median (25th percentile, 75th percentile) out-of-pocket costs for a 30-day supply in 2019 were largest for edaravone ($712.8 [$59.8–$802.0]) and eculizumab ($91.1 [$3.0–$3,216.4]). For new-to-market medications, the distribution of out-of-pocket costs was highly variable and the trends over time were unpredictable compared with existing guideline-supported medications.
Discussion Despite the increasing number of FDA-approved neurologic medications, utilization of newly approved medications in the privately insured population remains small. Given the high costs and similar efficacy for most of the new medications, limited utilization may be appropriate. However, for new medications with greater efficacy, future studies are needed to determine whether high costs are a barrier to utilization.
Glossary
- ALS=
- amyotrophic lateral sclerosis;
- ATTR=
- TTR amyloidosis;
- CADTH=
- Canadian Agency for Drugs and Technologies in Health;
- CDSS=
- clinical decision support system;
- CGRP=
- calcitonin gene-related peptide;
- DMD=
- Duchenne disease;
- EHR=
- electronic health record;
- FDA=
- Food and Drug Administration;
- HD=
- Huntington disease;
- ICD=
- International Classification of Diseases;
- ICER=
- Institute for Clinical and Economic Review;
- MAO-B=
- monoamine oxidase type B;
- MG=
- myasthenia gravis;
- MS=
- multiple sclerosis;
- OH=
- orthostatic hypotension;
- PD=
- Parkinson disease;
- RTBT=
- real-time benefit tool;
- SMA=
- spinal muscular atrophy;
- TD=
- tardive dyskinesia;
- TTR=
- transthyretin
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Rebecca Burch, MD.
Editorial, page 401
- Received May 9, 2022.
- Accepted in final form October 14, 2022.
- © 2022 American Academy of Neurology
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