Is teriflunomide overpriced?

I was at a meeting yesterday with some American colleagues and nearly fell off my chair when I heard  that teriflunomide has been priced at $45,000 per year for American MSers. Even more astounding was the news that glatiramer acetate and fingolimod have increased their prices to over $50,000 per year. Common wisdom would tell you that competition and the market would bring down the price of DMTs. This cycle of price rises is clearly madness and unsustainable. I predict a black swan is winging its way into the MS market and we will all suffer; in particular MSers. 

You may want to read the following editorial that gets to the heart of the issue:

Hauser SL, Johnston SC. Multiple sclerosis drugs: sticker shock. Ann Neurol. 2012 May;71(5):A5-6.

Two excerpts:

"Fewer than 0.1% of prescriptions written in the US are drugs for multiple sclerosis (MS), but these represent 3.1% of total drug costs. The global MS drug market is now estimated at $10 billion, and is predicted to experience double digit increases on an annual basis.1,3 Two MS drugs are now in the top 20 in terms of global sales: glatiramer acetate (Copaxone, produced by Teva) was #12 in 2011, with sales of $3.3 billion, followed by interferon beta 1a (Avonex, Biogen Idec) at #20 with $2.5 billion. Currently, drug costs account for more than half of the total cost of care for MS."

 "Not everyone pays the same price for drugs, of course, and rules that underlie various pricing levels in the US (Medicare, commercial, individual), added to negotiated rebates, patient assistance programs, and different rules for international buyers provide enough complexity to make the most seasoned economist’s head spin. However, it is clear that prices in the US are higher than almost anywhere else, and because of these prices the value of any drug will be lower. For example, the cost to provide one quality of life year (QALY) from an MS drug may be unacceptably high in the US – over $800,000 in one recent study.6 In the UK, by contrast, interferon treatment costs approximately $12,000 USD annually, and because of this lower cost, the value of MS drugs dramatically improves. One could reasonably argue that it is patently unfair for the American health care system to pay such a premium for these needed therapies. If overall pricing is justified, is the disproportionate US burden our gift to Europe and the rest of the world?"

"This issue needs serious discussion and debate!

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