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

Objectives: 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. Methods: 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. Results: 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. Discussion: 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.