by Eric Czarnick, PharmD and Cathy Ng, PharmD
Parkinson disease (PD) is a chronic, progressive neurodegenerative disorder presenting with symptoms of tremor, stiffness, slowness of movement, and postural instability. The severity of these symptoms increases as the disease progresses, which translates into escalating direct healthcare costs including prescription drugs, hospitalizations, and nursing home care. Current treatments are largely based on dopamine replacement agents and dopamine agonists, which help alleviate the symptoms, but no treatments have been approved to cure or slow disease progression. The majority of current treatments involve multiple daily doses, which may contribute to sub-optimal compliance and ultimately may increase direct and indirect healthcare costs. Kowal et al. estimated that approximately 630,000 people in the U.S. had been diagnosed with PD in 2010. The incurred medical expense exceeded $14.4 billion in 2010 (approximately $22,800 per patient), and indirect costs were conservatively estimated at $6.3 billion (close to $10,000 per patient). Due to a growing elderly population, disease prevalence and economic burden are projected to grow substantially over the next few decades.
General Cost of Prescription Medications
Express Scripts publishes an annual Drug Trend Report providing detailed analysis of U.S. prescription drug costs and utilization, as well as the marketplace factors that affect future changes. Table 1 provides the average annual cost ranges for medications per member, per plan according to the 2017 Drug Trend Report.
| Traditional Generic | Traditional Brand | Specialty Medications | |
| Commercial Plans | $0-$240 | $240-$720 | >$750 |
| Medicare | $0-$1000 | $1000-$2500 | >$2600 |
| Medicaid | $0-$300 | $300-$720 | >$720 |
(Table 1)
Cost of Parkinson Disease Medications
Table 2 provides the monthly costs (starting dose) of PD drugs in the U.S. versus Maine.
| Drug | Dosing | Monthly Costs in U.S.
(starting dose; 4 weeks supply) |
Monthly Costs in Maine | |
| Dopamine replacement agents | ||||
| carbidopa/levodopa
(Sinemet, Sinemet CR)
|
IR (starting dose): 25/100 mg PO TID
CR (starting dose): 50/200 mg PO BID |
Generic IR:
25/100 mg (100)= $80.02 ~$67.22/mo
Brand IR: 25/100 mg (100)= $157.02 ~$131.90/mo |
Generic IR:
25/100 mg (90) ~$36-79 (est. cash price) ~$17.23-34.97 (with coupon) |
|
| COMT inhibitors | ||||
| entacapone
(Comtan)
|
200 mg with each dose of carbidopa/levodopa
(max=1600 mg/day) |
Generic:
200 mg (100) = $395.48 ~$332.20/mo
Brand: 200 mg (100)= $925.37 ~$777.31/mo |
Generic:
200 mg (90) ~$97.74-179.41 (with coupon) |
|
| Dopamine agonists | ||||
| pramipexole
(Mirapex, Mirapex ER) |
IR: start with 0.125 mg PO TID, titrate weekly to max of 1.5 mg TID
ER: start with 0.375 mg PO daily, titrate weekly to max of 4.5 mg daily |
Generic IR:
0.125 mg (90)= $277.55 0.25 mg (90)= $277.55 0.5 mg (90) = $277.55 0.75 mg (90) = $265.47 1 mg (90) = $277.55 1.5 mg (90) $277.55 Any strength ~$259.05/mo
Brand IR: 0.125 mg (90)= $702.08 0.25 mg (90)= $702.08 0.5 mg (90) = $702.08 0.75 mg (90) = $702.08 1 mg (90) = $702.08 1.5 mg (90) $702.08 Any strength ~$655.27/mo |
Generic IR:
0.125 mg (90) ~$90-254 (est. cash price) ~$12.84-103.70 (with coupon) |
|
| ropinirole
(Requip, Requip XL) |
IR: start with 0.25 mg PO TID, titrate weekly to max of 8 mg TID
XL: start with 2 mg daily, titrate weekly to max of 24 mg daily |
Generic IR:
0.25 mg (100)= $250.00 0.5 mg (100)= $250.21 1 mg (100)= $250.00 2 mg (100)= $250.21 3 mg (100)= $259. 54 4 mg (100)= $259.86 5 mg (100)= $259.86 0.25 mg-5 mg ~$214.14/mo 6 mg-8 mg ~$428.28/mo
Brand IR: 0.25 mg (100)= $674.33 0.5 mg (100)= $674.33 1 mg (100)= $674.33 2 mg (100)= $674.33 3 mg (100)= $699.44 4 mg (100)= $699.44 5 mg (100)= $699.44 0.25 mg-5 mg ~$575.98/mo 6 mg-8 mg ~$1153.97/mo
|
Generic IR:
0.25 mg (90) ~$72-268 (est. cash price) ~$16.81-81.20 (with coupon)
|
|
| rotigotine
(Neupro) patch |
Start with 2 mg/24 hrs (early PD), apply once daily
Max: 8 mg/24 hrs |
Brand:
1 mg/24 hrs (30)= $775.94 2 mg/24 hrs (30)= $775.94 3 mg/24 hrs (30)= $775.94 4 mg/24 hrs (30)= $775.94 6 mg/24 hrs (30)= $775.94 8 mg/24 hrs (30)= $775.94 Any strength~ $724.21/mo
|
Brand:
2 mg/24 hrs (30) ~$771-804 (est. cash price) ~$650.64-696.48 (with coupon) |
|
(Table 2)
Prescription Drug Price Transparency
Recently, Maine state senator Eloise Vitelli introduced a prescription drug price transparency bill, which allows investigations by the Attorney General to collect and report on prescription drug prices, primarily on those that qualify for one or more of the following:
- The wholesale acquisition cost is $2500 or more annually or for a course of treatment;
- The wholesale acquisition cost of the drug has increased by 50% or more over the previous 5 years; or
- The wholesale acquisition cost of the drug has increased by 15% or more over the previous 12 months.
Once identified, the Attorney General shall require the manufacturer of the drug to disclose drug production, research and development costs, marketing and advertisement costs, and actual retail prices of the drug charged to purchasers. The bill also gives the Attorney General authority to levy fines and take action against drug manufacturers who fail provide the information. Similar measure has passed in Maryland and California to require drug makers publicly justify big price hikes.
REFERENCES
Economic burden associated with Parkinson disease in the United States. 2009. Drug Benefit Trends. 21(6), pp. 179-190
Compliance with pharmacotherapy and direct healthcare costs in patients with parkinson’s disease: A retrospective claims database analysis. 2013. Applied Health Economics and Health Policy. 11(4), pp. 395-406
The current and projected economic burden of Parkinson’s disease in the United States. 2013. Movement Disorders. 28(3), pp. 311-318
Direct costs and survival of medicare beneficiaries with early and advanced parkinson’s disease. 2012. Parkinsonism and Related Disorders. 18(4), pp. 321-326
Maine LD 1406
https://legislature.maine.gov/legis/bills/bills_128th/billtexts/SP048401.asp
Maryland
Califronia
2017 Express Scripts Drug Trend Report. http://lab.express-scripts.com/lab/drug-trend-report/2017-dtr
Eric Czarnick, Pharm.D., and Cathy Ng, Pharm.D., graduated from the University of New England College of Pharmacy in May. This writing project was mentored prior to graduation by Hailey Choi, Pharm. D., BCACP, CDE, Assistant Clinical Professor, Department of Pharmacy Practice, University of New England College of Pharmacy.
