The journal Neurology recently published an article by lead author Brian Callaghan, MD at the University of Michigan, reporting the results of a study examining monthly out-of-pocket costs for commonly prescribed neurology medications. The authors determined that the costs for medications that treat five common neurologic diseases – multiple sclerosis (“MS”), peripheral neuropathy, epilepsy, dementia and Parkinson’s disease – have increased “considerably” over the last 12 years, particularly for patients with high-deductible health plans.
The authors examined a population of over 900,000 neurology patients, each with one of the five enumerated diseases. They compared the out-of-pocket costs for high-deductible health plans to traditional plans. They also determined the cumulative out-of-pocket costs for the first two years following diagnosis for conditions with high-cost (MS) and low/ medium-cost (epilepsy) medications. The authors determined that MS patients saw the fastest rise in monthly out-of-pocket expenses, increasing from a mean of $15 per month in 2004 to $309 in 2016. The authors also found that patients with high-deductible health plans had approximately twice the out-of-pocket expenses as those in traditional plans, with monthly means of $661 and $246, respectively. Finally, the study found that the cumulative two-year out-of-pocket costs rose “almost linearly” with time in MS ($2,238) and epilepsy ($230). In conclusion, the authors noted that neurologists need access to cost information when making treatment decisions in order to minimize patient financial burden.
On June 7, 2019, Dr. Callaghan spoke to National Public Radio to discuss the results of the study. When asked about the causes of the upward trends in out-of-pocket costs, Callaghan noted that the rising costs are due to insurance companies shifting costs to patients. He indicated that these costs are implemented as either increased copays or higher deductibles. Callaghan also said that physicians are often not aware that patients are paying more out-of-pocket, because most patients are reluctant to talk to their physicians about costs, and because there is little time available during an appointment to have such a discussion. Unless patients provide them with the information, doctors do not have access to their patients’ out-of-pocket costs.
Callaghan concluded that patients and physicians need to start talking about these prices issues, and noted that this problem is not unique to drugs used to treat neurologic conditions. He also said that he has undertaken a new study to measure how much the out-of-pocket cost of a drug affects patient compliance with taking the drug, as there is a lot of evidence to suggest that patients are not filling prescriptions at all for drugs with high out-of-pocket costs, or are rationing them by taking lower than prescribed doses.