Changes in List and Net Prices for Multiple Sclerosis Disease-Modifying Therapy, 2013 to 2021

The objective of this study was to evaluate changes in net and list prices of branded multiple sclerosis (MS) disease-modifying therapies (DMTs) between 2013 and 2021.

Using several pharmaceutical pricing and utilization data sources, we estimated list and net (after rebates and discounts) prices for branded monoclonal antibody (MAb) and oral DMTs. We calculated the inflation-adjusted list and net prices for each DMT, the manufacturer discount as a percentage of list price, the average annual change (AAC) in prices, and the cumulative change in list price offset by discounts.

From 2013 to 2021, oral DMT list prices increased from $73,924 to $104,372 (5.3% AAC) while net prices rose from $69,187 to $82,181 (1.5% AAC) because of increasing manufacturer discounts (6.4%-21.2%). From 2014 to 2021, MAb DMT list prices increased from $70,320 to $92,109 (4.1% AAC), with net prices rising from $55,109 to $79,396 (3.0% AAC). Discounts offset 51%-86% of cumulative list price increases for oral DMTs (fingolimod, teriflunomide) vs 0%-35% for MAb DMTs.

The divergent net pricing trends between oral and MAb DMTs may reflect increasing brand and generic competition among oral DMTs and a lack of biosimilar options among MAb DMTs.