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

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