January 2020

I want to wish all of you a productive and safe 2020. I am delighted to announce that the ANA has signed a contract with our management company, Association Headquarters (AH), for another 3 years. I look forward to working with Nadine Goldberg and her great staff in organizing great meetings and pushing the ANA to have an even greater impact.

Over the holidays I have been reading a lot about the challenges to health care in the US. Recognizing that the current costs of health care approaching 20% of GDP are not sustainable, I have focused my attention on one element of health care costs that we, as providers, have some degree of input on ~ drug prescriptions. Medication costs constitute about 10% of the total (in 2017, US health care costs were 3.5Tn), and between 1997 and 2007, drug prices tripled, according to a study in Health Affairs. As of January 2020, the prices of 499 drugs increased literally overnight by an average of 5.2% as reported by researchers at GoodRx. For one disorder, MS, tremendous advancements have been made in disease modifying therapies. At the same time, annual Medicaid expenditures on DMTs have increased from $453 million in 2011 to $1.32 billion in 2017, in part because of the deployment of newer and more expensive drugs, but Hartung et al have identified other drivers of cost including “the existing price ecosystem, overall corporate growth, international pricing disparities, and supply chain–related distortion” (1). Generics have been developed for some DMTs, but have not had a significant effect to reduce costs (2) and probably will not until there are 3-5 generics for each brand name drug.
 
With this background, what might we do as academic neurologists?

Educate ourselves and our patients on the relative costs of generics and brand name drugs (www.goodrx.com is one site)
Prescribe thoughtfully, and prune medication lists regularly.
Join efforts to lobby Congress to control drug costs. It seems that the Senate is most unlikely to pass a pending bill passed by Democrats in the House of Representatives in December 2019, which would empower the government to directly negotiate drug prices and cap prices at 1.2x their cost in other countries. This is one of the areas I will speak with Members of Congress about when attending the Society for Neuroscience’s (SfN) Capitol Hill Day on March 5.
Support and engage with efforts by state governments to control drug prices. For example, Maryland just introduced a drug board that includes clinicians, pharmacist, and health-care economists and has been charged with identifying prescription drugs whose costs rose by specific amounts over one year and thus could cause “affordability challenges” for patients and the state health-care system.
Use our relationships with industry to put pressure to provide patient assistance programs for expensive drugs. An excellent example has been set by Biogen with their life-transforming Spinraza™ that has a first year cost of $750,000 (website SMA360™).
Warm regards,

Justin C. McArthur, MBBS, MPH
President, American Neurological Association
John W. Griffin Professor of Neurology and Director, Department of Neurology
Johns Hopkins Medicine