Evidence map›Paper›PMID 34484929›Full record

ArticleNeurology. Clinical practice2021

Closing the Part D Coverage Gap and Out-of-Pocket Costs for Multiple Sclerosis Drugs.

Daniel M Hartung, Kirbee A Johnston, Dennis N Bourdette, Randi Chen, Chien-Wen Tseng

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurology. Clinical practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Economics of Multiple Sclerosis Disease-Modifying Therapies in the USA.Current neurology and neuroscience reports · 2021
    Review
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Daniel M HartungCollege of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.ORCID 0000-0002-0685-773X
Kirbee A JohnstonCollege of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.
Dennis N BourdetteCollege of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.
Randi ChenCollege of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.
Chien-Wen TsengCollege of Pharmacy (DMH, KAJ), Oregon State University, Portland; Department of Neurology (DNB), Oregon Health & Science University, Portland; Pacific Health Research and Education Institute (RC, C-WT), Honolulu, HI; and Department of Family Medicine and Community Health (C-WT), University of Hawai'i John A. Burns School of Medicine, Honolulu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo determine whether closing the Part D coverage gap (donut hole) between 2010 and 2019 lowered patients' out-of-pocket costs for disease-modifying therapies (DMTs) for multiple sclerosis (MS).

methodsUsing nationwide Medicare Formulary and Drug Pricing Files, we analyzed Part D drug benefit design and DMT prices in 2010, 2016, and 2019. We calculated average monthly list prices for DMTs available in each year (4 DMTs in 2010, 11 DMTs in 2016, and 14 DMTs in 2019). We projected patients' annual out-of-pocket cost for each DMT alone under a standard Part D plan in that year. We estimated potential savings attributable to closing the coverage gap between 2010 and 2019 (beneficiaries' cost sharing dropped from 100% to 25%) under 3 scenarios: no increase in price, an inflation-indexed price increase (3% annually), and the observed price increase.

resultsMedian monthly DMT prices rose from $2,804 to $5,987 to $7,009 over the years 2010, 2016, and 2019, respectively. Median projected annual out-of-pocket costs rose from $5,916 to $6,229 to $6,618. With unchanged or inflation-indexed DMT price changes, closing the coverage gap would have reduced annual out-of-pocket costs by $2,260 (38% reduction) and $1,744 (29% reduction), respectively. Despite having the lowest monthly price, generic glatiramer acetate had among the highest out-of-pocket costs ($6,731 to $6,939 a year) in 2019.

conclusionsMedicare Part D beneficiaries can pay thousands of dollars yearly out of pocket for DMTs. Closing the Part D coverage gap did not reduce out-of-pocket costs for patients because of simultaneous increases in DMT prices.

Identifiers

PMID34484929
PMCPMC8382442

What OpenQuestion holds

Textmetadata
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.