Business of Medicine

By Steve Barrett
Friday, November 1, 2019

MS Patients on Medicare Face Rising Costs

Complex rules are forcing Medicare patients diagnosed with MS to pay vastly more for care, new research finds.

Under the rules, patients must pay a significantly higher share of the cost for therapies to treat the condition, according to a study in Health Affairs.

Annual out-of-pocket spending among Medicare beneficiaries who do not receive low-income subsidies is now nearly $7,000, researchers determined. Use of generic drugs is no guarantee of lower prices, they point out.

“In one telling example, researchers documented how patients who are prescribed the only generic drug in one class — glatiramer acetate — will pay more out of pocket than patients using any of the other brand-name drugs in the same class,” states a news release about the findings.

The reason? 2018 legislation aimed at lowering prices for brand-name drugs ultimately resulted in certain generics used to treat MS costing more than their brand-name versions.

Spending Falls Among Patients Paid to Seek Cheaper Care

Healthcare spending dropped when patients received financial incentives to have certain elective procedures performed by lower-priced providers, a study in Health Affairs finds.

Payments to patients in a Blue Cross Blue Shield rewards program in five states ranged from $25 to $500 and covered 135 procedures. Including administrative costs, the average price paid for all covered services fell 2.1%. The largest drops were 4.7% for MRIs, 2.5% for ultrasounds and 1.7% for mammograms.

“Employers increasingly are turning to financial reward programs as a strategy to cut costs,” Christopher M. Whaley, lead author of the study and an Associate Policy Researcher at the nonprofit research organization Rand Corp., states in a release about the findings. “We found these efforts to be modestly successful, especially for imaging services.”

The study did not evaluate the quality of the procedures.

Access to Addiction-Treating Drug Too Limited, Study Finds

Between 2007 and 2018, Medicare Part D beneficiaries’ access to buprenorphine, a drug used to treat addiction, became increasingly restricted, researchers wrote recently in a letter in JAMA.

They cited efforts by insurers to control costs as a driving force for this change.

The medical community is more widely embracing use of such medications among people with opioid use disorder, according to the scientists. Yet only 35% of insurance plans offered unrestricted access to buprenorphine in 2018, compared with 89% in 2007.

“Many people still believe that medication treatment isn’t really recovery,” states co-author Todd Korthuis, MD, MPH, Professor of Medicine and Public Health and Preventative Medicine in the Oregon Health & Science University, in a news release. “Overwhelming scientific evidence supports that medicines like buprenorphine are far more successful and safer than abstinence-only approaches.”