Prices for multiple sclerosis (MS) drugs have risen sharply in the last 15 years, far outpacing inflation and substantially increasing costs for the people who must take these medicines. Even the introduction of several new MS drugs has not caused the older drugs to drop in price, as market expectations predict should happen in the face of competition. In fact, the entry of these new treatmentss may have actually contributed to their skyrocketing prices, a study suggests.

It's not a story of medicine at its best.

Medicare is spending over three times as much for drugs to treat one single illness as they are paying to neurologists for treating all their patients.

Multiple sclerosis is an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body. Between 2006 and 2016, the average cost for a year's supply of MS drugs more than quadrupled, jumping from about $18,000 to $76,000 per year. But this is based on list price, and as with most commodities, not everyone pays list price. So researchers from the University of Pittsburgh dug a little deeper to determine how much people were actually paying for the MS drugs.

In 2016, Medicare was paying ten times as much for these drugs as they had been in 2006 and people's share of the bill — their out-of-pocket costs — rose over seven-fold.

These are estimates the researchers calculated by looking at a random sample of about 2.8 million Medicare claims each year from 2006-2016 and totaling the amount that was for MS drugs.

Before 2009, there were only four approved drugs that you could buy and take at home to help manage MS symptoms. Since then, seven new drugs have entered the market. But despite the increased market competition, prices have been rising steadily for nearly all of them.

“One of the most significant findings was that the prices of these drugs have increased in parallel,” said study lead author, Alvaro San-Juan-Rodriguez, a Research Fellow at the University of Pittsburgh School of Pharmacy. “Only a couple exceptions deviate from that general trend.”

In 2017, Medicare Part D spent more than $5 billion on these 11 drugs. An editorial accompanying the study offers some perspective on just how much that is: Medicare paid all neurologists a total of about $1.4 billion in 2016 for all their services and procedures. So Medicare is spending over three times as much for drugs to treat one single illness as they are paying to neurologists for treating all their patients.

The editorial, by researchers at Oregon Health & Science University, also notes that prices for MS drugs only increased moderately until 2002. That was the year that the drug interferon beta-1a (Rebif) was introduced at a price about 30 percent higher than existing MS treatments. This was the beginning of the general steep rise in MS drug prices.

The force that is driving these price increases remains unclear, but the authors of the editorial suggest what it might be: “[T]he simplest explanation is that pharmaceutical and biotechnology companies increase prices because they can, they do it to increase their profit margins, and there are few limits on what they can charge.”

Both the article and editorial appear in JAMA Neurology.