Objective:

To estimate out-of-pocket (OOP) costs for disease-modifying therapies (DMTs) among Medicare Part D beneficiaries with multiple sclerosis (MS) under different scenarios.

Background:

Recent developments such as the passage of the Inflation Reduction Act (IRA) and availability of direct-to-consumer (DTC) pharmacies could lower OOP costs.

Design/Methods:

We estimated Part D OOP costs for brand-name DMTs under three scenarios: (i) in 2023 before IRA implementation, (ii) in 2025 after the IRA introduces a $2,000 annual OOP maximum, and (iii) in 2025 after the $2000 OOP maximum is combined with monthly payments via voluntary enrollment in the Medicare Prescription Payment Plan (MPPP). We also compared OOP costs for generic DMTs under the above three scenarios vs. direct cash purchase via DTC pharmacies.

Results:

In 2023, estimated annual OOP costs ranged from $6,275 to $8,992 for brand-name DMTs. Under the 2025 Part D benefit, all brand-name DMT users will reach the new annual OOP maximum, with the entire $2,000 frontloaded in January unless beneficiaries enroll in MPPP. Enrolling in MPPP could lead to monthly payments as low as $167 for DMTs (a reduction of over 90% in monthly OOP costs for January). Purchasing generics through DTC pharmacies may reduce costs for some but not all generic DMTs.

Conclusions:

For Medicare beneficiaries with MS, OOP costs for DMTs will decrease significantly beginning January 1, 2025 due to the IRA’s $2,000 OOP maximum. Beneficiaries who voluntarily enroll in the MPPP will also be able to spread OOP costs in monthly installments (as little as $167 per month). Direct cash purchase of some generic DMTs through DTC pharmacies instead of via the Part D benefit could also lower costs for Medicare beneficiaries. Neurologists have a critical role in ensuring Medicare beneficiaries are aware of the option to enroll in the MPPP and the possibility of filling generic DMTs via DTC pharmacies.