Neurologists and the economics of MS treatment

It is understandable that neurologists might “curse the darkness” that engulfs the economics of multiple sclerosis (MS) care. The price of MS disease-modifying therapies (DMTs) is shocking. In 2013, the average wholesale price of all MS DMTs in the United States clustered around $65,000 a year and prices continue to increase by more than 10% per year.¹ In response to skyrocketing DMT prices, insurance companies and specialty pharmacies create rules regulating coverage of MS treatments with little input from neurologists.² Neurologists must navigate Kafkaesque health insurance bureaucracies to obtain coverage for treatments we deem appropriate for our patients. By contrast, reimbursements for neurologists illustrate that we may be undervalued. In 2013, Medicare spent $820 million for a single MS DMT, glatiramer acetate, which nearly equaled the $939 million paid to all neurologists for their evaluation and management services.³ Neurologists, the experts in the care of MS, have no influence over the rising cost of DMTs or the decisions made by the health insurance industry regarding coverage of therapies. Frustrated neurologists complain at meetings and via e-mail groups about medication cost and lack of influence, generating much heat but little light.