Study Results Show High Costs, Similar Benefits Lead Patients to Forgo Neurology Drugs


Despite the increasing approval of neurological medications, just a small percentage of individuals are using them because of skyrocketing out-of-pocket expenses.

Despite the increasing approval of neurological medications over the past decade, just a small percentage of individuals with conditions, such as migraines, multiple sclerosis (MS), and Parkinson disease (PD), are being treated with these new drugs, because of high out-of-pocket costs and benefits similar to existing drugs, according to the results of a study published in Neurology.

“Our study of people with neurologic conditions found fewer than 20% were being treated with new medications,” Brian Callaghan, MD, MS, of University of Michigan Health in Ann Arbor and a fellow of the American Academy of Neurology, said in a statement.

“For new, high-cost medications that have similar effectiveness to older drugs, limited use is likely appropriate,” he said. “However, future studies are needed to look into whether the high costs are barriers to those new medications that can really make a difference for people living with neurologic disease.”

Investigators used a private insurance claims database to identify individuals with 11 neurologic conditions and a prescription for either an existing or new drug.

They included 2.3 million individuals with migraines, 76,990 with multiple sclerosis (MS), 67,917 with PD, 57,259 with orthostatic hypertension, 22,936 with myasthenia gravis, 6257 with tardive dyskinesia, 4180 with amyotrophic lateral sclerosis, 2277 with Huntington disease, 267 with transthyretin amyloidosis, 163 with Duchenne disease, and 10 with spinal muscular atrophy.

Investigators looked at the usage of existing vs new medications.

“New” was defined as drugs that received FDA approval between 2014 and 2018, which included erenumab, fremanezumab, and galcanezumab for migraines, and ocrelizumab and peginterferon beta-1a for MS.

Fewer than 20% of individuals were taking new medications for all conditions, except for tardive dyskinesia at 32%, when investigators calculated the proportion of individuals receiving new medications compared with all medication.

Additionally, investigators calculated the average out-of-pocket cost for a 30-day supply of each medication, with the 2 most expensive drugs being edaravone at $713 per month and eculizumab at $91 per month.

Overall, the out-of-pocket and total costs for new drugs were substantially larger than existing drugs and were also highly unpredictable and variable.

“We are living in a time when new treatments bring hope to people with neurologic diseases and disorders,” Orly Avitzur, MD, MBA, FAAN, president of the American Academy of Neurology, said in a statement.

“However, even existing prescription medication can be expensive and drug prices continue to rise. In order for neurologists to provide people with the highest quality care, it is imperative that new drugs are accessible and affordable to the people who need them,” Avitzur said.

Limitations of the study included that the follow-up time was short for some of the more recently approved medications and the number of individuals in the study with rare diseases was small.

New medication for the rare diseases spinal muscular atrophy and transthyretin amyloidosis have dramatically changed care, but the small number of individuals in the study did not allow for them to make conclusions about the effects of cost on the use of these medications, investigators said.


With high costs and similar benefits, use of new neurology drugs is low. EurekAlert. News release. November 30, 2022. Accessed December 12, 2022.

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