Annette M. Langer-Gould, MD, PhD, Kaiser Permanente Southern California
The unaffordability of MS medications is driven by the outrageous prices that are in no way tied to the benefits these medications provide.
The experiences they share include a few simple strategies to lower costs without diminishing quality of care. The one with the most impact is the use of rituximab- the forerunner to ocrelizumab that will likely be FDA approved and available for a ridiculously high price in 2017.
The biggest barriers to implementing rituximab use are:
1) most insurance carriers deny coverage because it is not FDA approved for MS;
2) neurologists are afraid of legal action if they prescribe a non-FDA approved product and
3) the drug companies are incredibly good at marketing their products with glossy ads to promote brand bonding, enticing many prominent neurologists with speaker fees, dinners, first-authorship on New England Journal articles for studies they didn’t design, conduct, analyze and so on. (ProfG didn’t mention this;-)
Biogen and Roche are already busy creating false distinctions between ocrelizumab and rituximab as they did for Lucentis and Avastin and frightening neurologists into believing they would be harming their patients or at risk of litigation if they use rituximab.
Off-label prescribing is what neurologists do all the time, the only legal risk is if ocrelizumab had been proven to be superior or safer than rituximab, data that do not exist and a study Roche and Biogen would be afraid to conduct.
The Swedish and Kaiser Permanente neurologists negotiated with their medical centers to allow the use of rituximab in their highly active patients when natalizumab was not an option.
Use of rituximab has increased dramatically in Sweden and Kaiser Permanente as the highly favorable efficacy/safety profile and high patient satisfaction becomes clearer.
Pharma tried to pressure the Swedish government to halt this use of rituximab, which was met by outrage from their neurologists.
Swedish health care authorities reviewed the extensive use of rituximab in MS and deemed it scientifically sound and legal. I urge all neurologists to stand up for their patients as the Swedish neurologists have done and help your patients get access to rituximab.