The High Cost of Innovation: Navigating Rising Drug Prices in Neurology

Amy Tsou, MD, MSc

As more therapies enter the field of neurology, particularly innovative treatments like gene therapies, monoclonal antibodies, and other biologics, the cost of drugs is rising sharply. Thes therapies hold significant promise for treating complex neurological conditions, many of which were previously considered untreatable or had limited options. However, the advanced science behind these drugs and the small patient populations they target often mean high development costs that are passed on to patients and healthcare systems.

At the 2024 American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) meeting, held October 15-18, in Savannah, Georgia, Amy Tsou, MD, MSc, gave a plenary talk on the ethics and economics of high-cost medications. In her talk, she discussed key ethical considerations and challenges to distributive justice arising from high drug prices and the potential impact of this and other structural factors on healthcare delivery. In addition, she provided insight on factors such as demands on physician’s time and burnout, healthcare financing, tradeoffs, and potential policy solutions.

Following the meeting, Tsou, program director at the National Institutes of Neurological Disorders and Stroke, gave additional clinical insight on her presentation and why it was a relevant topic matter. Tsou, who also serves as an adjunct professor of neurology at the Perelman School of Medicine at the University of Pennsylvania, discussed the high cost of medications, ethical concerns of drug pricing, impact on healthcare providers, and the role of clinicians. Furthermore, she provided potential policy solutions, such as the Inflation Reduction Act of 2022, which may ultimate help in the negotiation process of drug prices.

NeurologyLive: Give an overview of your presentation, and why this was a topic of interest for you?

Amy Tsou, MD, MSc: The presentation focused on a key issue for many Americans: the high cost of drugs and the challenges this can create for patients, healthcare providers, and payers.Today, there are groundbreaking innovations (for instance, gene therapies) that have unlocked treatments for many diseases—but realistically, the cost for these treatments means many patients are unlikely to be able to have access. In 2022, the US spent over 400 billion dollars just on prescription drugs – and many projections show costs are expected to keep rising.

Clinicians –and really everyone that works in the healthcare system—are so busy on a day to day basis. It’s sometimes hard to have time to connect how these issues with how drugs are priced actually impact our day to day work in the clinic.

What are some of the main key ethical concerns and challenges with high drug prices? Discuss some of the downstream effects as well.

These high prices create a direct challenge to distributive justice –which is the ethical principle concerned with whether benefits and burdens are fairly distributed across society. People who don’t have health insurance may be unlikely to be able to afford expensive drugs. However, we know that cost is a problem even for Americans that have coverage. Surveys have shown that Americans report either skipping medications altogether or skipping doses because of cost, which can result in negative health outcomes.

Many payers restrict access to expensive treatments by requiring prior authorization. While of course, we all want therapies to be used appropriately, in practice, the time and resources required to complete these prior authorizations has become a real burden for physician practices. In fact, a recent AMA survey found that on average physicians reported completing 43 prior authorizations a week, which took them and their staff 12 hoursa week to complete.One study even found that neurologists specifically cited prior authorizations as something contributing to burnout. We already know burnout, from a variety of causes, is an issue for neurologists. Since demand for neurologists is expected to rise (due to an aging population among other factors) if neurologists leave the field early because of burnout – odds are, this will make existing treatment disparities that people with neurologic diseases already deal with even worse.

What potential policy solutions can be implemented to mitigate the impact of high drug prices?

The Inflation Reduction Act which was passed in 2022, allowed Medicare to negotiate drug prices for the very first time. Countries around the world all negotiate drug prices, but until now, Medicare has not been allowed to do that, even though is it the largest public purchaser of drugs. The first round of negotiations for 10 high cost medications was completed last August and will go into effect in January of 2026. These negotiations are projected to save 98 billion dollars over the first decade. Additional benefits of the Inflation Reduction Act include a $2000 cap on out-of-pocket prescription drug costs in Medicare and a new inflation rebate for Medicare Part B rebatable drugs.

Is this an issue that will naturally subside as more therapeutics in neurology become available? Or do you not foresee that being the case?

This is hard to predict – but I would certainly hope so.

Going forward, what role can clinicians play in helping solve some of the issues with the economics of high-cost medications?

This isn’t something that any individual clinician can “fix” on their own, but increased awareness among healthcare providers of both the direct and indirect costs associated with high-cost medications may be helpful.