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Medicare rules increase out-of-pocket costs of multiple sclerosis drugs

February 07, 2019 / Jeff Lagasse

Medicare patients with multiple sclerosis face skyrocketing out-of-pocket costs for therapies due to complicated insurance rules that force them to pick up an increasing share of the cost, according to new research. Despite recent efforts to constrain escalating costs, researchers with OHSU and the OHSU/Oregon State University College of Pharmacy in Portland, Oregon found trends in insurance coverage that restrict access and saddle patients with increasing patient costs. The conclusion: Medicare beneficiaries without low-income subsidies can expect to spend $6,894 a year out of pocket for treatment of MS. The authors call the market "dysfunctional," lacking the typical incentives of most other consumer products. There are few incentives for companies to not raise prices because higher prices benefit those in the drug distribution channel, including drug companies.