Neurologic Medication Costs in a Direct-to-Consumer Pharmacy vs Commercial Insurance Plans.

IMPORTANCE

Given increasing costs of neurologic medications, there is a need to explore alternative options to minimize medication spending.

OBJECTIVE

To compare 2024 neurologic medication costs from commercial insurance plans with those available in the Mark Cuban Cost Plus Drug Company, a direct-to-consumer pharmacy.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study compared medication costs through a direct-to-consumer pharmacy with model-estimated 2024 costs from commercial and Medicare supplemental databases. Commercial insurance plan costs from 2012 to 2021 were used. The direct-to-consumer pricing for each medication was obtained from the website on December 10, 2024.

MAIN OUTCOMES AND MEASURES

The difference between direct-to-consumer and overall commercial insurance plan annual out-of-pocket (OOP) costs and total costs were calculated. Total and OOP costs were separately compared between direct-to-consumer and generic-only commercial prices. Aggregate cost differences were presented for OOP and total costs.

RESULTS

Among 79 neurologic medications considered, 33 medications (42%) available for purchase through the direct-to-consumer pharmacy were studied. The direct-to-consumer pharmacy OOP costs were 75% higher and total costs were 413% lower than commercial pharmacies. Among observed medications, teriflunomide (-40%) and droxidopa (-18%) had lower OOP and total costs in the direct-to-consumer pharmacy, with no other medications having lower OOP costs in the direct-to-consumer pharmacy. In generic-only costs, no direct-to-consumer pharmacy medications had lower OOP annual cost. In total costs, 55% of the direct-to-consumer pharmacy medications had lower total annual cost. Teriflunomide (-5600%), droxidopa (-4800%), and dimethyl fumarate (-1900%) had the largest percentage reduction in the direct-to-consumer pharmacy. In aggregate, if all commercial prescriptions were filled in a direct-to-consumer pharmacy, the aggregate OOP expenditures would increase by $82 million.

CONCLUSIONS AND RELEVANCE

Practitioners should be aware of options such as direct-to-consumer pharmacies because they can often deliver similar OOP costs for uninsured patients to conventional pharmacies in commercial insurance plans. If pharmacies with direct-to-consumer pharmacy cost structures were widely used, total prescriptions may be markedly reduced.