Why is multiple sclerosis (MS) medication so expensive?

Generally, medical treatments for multiple sclerosis, a condition that requires lifelong care, are hellaciously expensive. This is true despite introductions of generic versions, and average U.S. retail prices are usually in the thousands of dollars. Medication in the U.S. is always expensive, but MS medications are in another realm entirely, up there with treatments for cancer and rheumatoid arthritis. A 2020 study published by the American Academy of Neurology found that Medicaid spending on MS disease-modifying therapies (DMTs) grew by more than 100% between 2011 and 2017. This was due to increases in prescription prices alone.

Why are multiple sclerosis (MS) drug prices so high?

Multiple sclerosis is a unique condition. It is an autoimmune disease of the central nervous system in which immune cells eat away at the connections between brain cells. There is no cure. In some patients, it can result in permanent brain damage. In others, symptoms are quite subtle at first and may not appear for many years. Because this condition varies so widely between patients, treatment does as well. Health care providers tailor MS treatments to the person diagnosed with it. Treatments for MS are focused on slowing the progression of the disease and helping with symptoms. As a result, any changes in drug therapy are difficult to manage and are closely monitored.

The MS Medication Market

Because there is no cure and the disease has so many variations, the pharmaceutical industry frequently debuts new MS medications, the result of years of clinical trials and research and development. Since 2017, the FDA has approved three new prescriptions for treatment of MS: Mayzent, Mavenclad, and Ocrevad. Each drug has costs in the hundreds of thousands of dollars. And even the generic ones will cause sticker shock, most likely due to the constant treatment tweaks.

The unfortunate truth is that, for drug companies, the MS medication market is booming. In 2019, Novartis made $3.223 billion in net sales on Gilenya, a popular MS prescription. Gilenya (fingolimod) does not yet have a generic alternative available on the market, although the FDA approved three in December 2019. In fact, Gilenya’s manufacturer, Novartis, filed four lawsuits in 2018 to prevent generic alternatives from entering the market. A U.S. district judge in Delaware ruled in favor of the company, resting his decision on Novartis’ separate campaign to extend its patent. (Currently, the patent lasts until 2027.) Meanwhile, a New York judge recently dismissed a 2013 lawsuit against the company which claimed Novartis received kickbacks for pushing Gilenya!.

According to big drug companies, drug prices are so high in America due to a need for “research and development” funds. The idea is that drug companies need big profits in order to have money to develop new drugs. For MS drugs, in the eyes of courts, this argument has legs. (As for savvy healthcare consumers, we have it on good authority that drug companies spend more money on marketing and advertising than on drug development.)

Where can I find less expensive MS drugs?

A good number of MS medications are covered by insurance plans, which means you will only have to pay a percentage of the cash price. Even these copayments and coinsurance payments can be high.

Unfortunately, health insurers make it exceedingly difficult to obtain MS medications even though they are covered! Betaseron, one of the more well-known MS drugs, is on the ExpressScripts formulary. The CVS Caremark formulary lists ten multiple sclerosis drugs, but with a caveat: They can only be prescribed with step therapy, and you may need prior authorization (requiring approval from your provider). Even with those two qualifications, your insurer may place a quantity limit on your Betaseron prescription. It's best to check with your provider to see which medication can be the easiest to get covered by your health insurance.

Related: What is prescription drug step therapy?

The few medications with generic counterparts have vast savings, especially at international pharmacies. You can save 75% on generic Copaxone (glatiramer acetate) at an international pharmacy. Even some of the brand name medications have steep declines in price abroad: Gilenya gets cheaper by 80% if you order internationally, and Aubagio can be found for 82% less from an PharmacyChecker-accredited international online pharmacy.

Pharmacist Note: Many MS drugs require refrigeration, which restricts their access. At this time, accredited international pharmacies do not ship drugs that require refrigeration due to safety precautions, which means you may be stuck finding the drug locally.

Sources: Average U.S. Retail Price calculated based on pricing on GoodRx.com. PharmacyChecker U.S. Discount Card Price based on availability at pharmacies near New Orleans, Louisiana. Lowest Accredited International Pharmacy Price based on prices listed on PharmacyChecker.com.

Where are MS drugs manufactured?

Tecfidera sold in the U.S. is manufactured in Switzerland, as are Gilenya and Mayzent. Aubagio, glatopa (generic Copaxone), and Betaseron -- those sold in the U.S. -- are products of Germany.

Learn more about multiple sclerosis and online pharmacy safety

How can I determine where a drug is manufactured?

Can a pharmacy fill a prescription early?

Why are brand-name drugs so expensive?

Do you have questions or concerns about safely accessing medication, whether locally or online? We’re here to help.