Payers May Cover Experimental Multiple Sclerosis Treatment Despite High Cost

Jul 24
Jul 24, 2025

A recent analysis from the Institute for Clinical Economic Review (ICER) found that the likely price of tolebrutinib, an experimental multiple sclerosis medication, greatly exceeds the organization’s cost-effectiveness threshold. However, Foluso Agboola, ICER’s senior vice president of research, tells AIS Health that payers may still cover the medication because there are currently no FDA-approved medications for non-active secondary progressive MS (SPMS).

Sanofi, the drug’s manufacturer, has not disclosed the list price of tolebrutinib, on which the FDA is expected to make an approval decision on in September. ICER assumed the list price would be $115,000 based on projections from IPD Analytics, a price that is similar to other branded oral MS drugs. But based on its analysis, ICER estimated that tolebrutinib would meet the commonly cited cost-effectiveness thresholds at an annual price of $3,250 to $5,900. Agboola observes that even though PBMs typically negotiate discounts off drugs’ list prices, there would need to be a “very huge discount” for the medication to be cost-effective.
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Tim Casey

Tim has been a reporter and editor for newspapers, websites and magazines for more than 20 years, including 10 years covering health care business topics. He has a deep knowledge of the managed care industry and pharmacy benefit management. He also has experience covering medical conferences and clinical and legislative health care issues. In 2014, the Society for Advancing Business Editing and Writing selected Tim as one of 15 journalists to participate in a national symposium on the Affordable Care Act. Tim has a B.A. in Psychology from the University of Notre Dame and an M.B.A. from Georgetown University.