Insurance Coverage Worsening for MS Drugs

July 14, 2016

A new survey of more than 6000 US patients with multiple sclerosis (MS) suggests that insurance coverage for disease-modifying therapies (DMTs) is worsening, with many patients struggling to be able to pay for their treatment.

The survey also found that some patients were not taking DMTs for financial reasons or were skipping doses to cut costs.

"If the costs of disease-modifying therapies continue to rise as they have over the last 5 years, we can expect that they will become unattainable for many individuals with MS," the authors conclude.

The survey, published online in Neurology on June 29, was conducted by a team led by Guoqiao Wang, PhD, from the University of Alabama, Birmingham.

The survey was conducted in 2014 and included 6662 people with MS who were active members of the North American Research Committee on MS (NARCOMS), a voluntary self-report registry.

Nearly all (98.5%) patients reported having some form of medical insurance, with 42.3% having only private insurance, 22.3% only public, 20.4% private and public, and 14.9% public with a supplemental.

While most reported that their insurance had not changed from the preceding year, 22.1% reported that they had worse coverage, with 7.8% of respondents experiencing some obstacle to insurance coverage of a DMT, most commonly denial of coverage.

Although 80.6% of the patients with relapsing-remitting MS (RRMS) were taking a DMT, 9.2% of such patients reported not taking a DMT because of financial or insurance reasons. Compared with those taking a DMT, those not doing so tended to be older, unemployed, and male and had lower incomes, longer disease duration, and more severe disability.

A quarter of those taking a DMT reported using a pharmaceutical supported program that provided their drug at no cost or a heavily discounted price. "The extensive use of free or discounted drug programs…suggests an important gap between health insurance needs and current coverage," the authors state.

"Financial burden and lack of insurance coverage of DMT use directly affected access to any DMT for a large number of respondents and posed challenges for respondents and their physicians with respect to the choice of DMT," they add.

They suggest that these negative effects likely reflect the dramatically increased cost of DMTs and the response to those high costs by insurance carriers. "However, the cross-sectional study design prevents us from confirming the conjecture that initial denial of coverage for DMTs occurred more frequently now than previously."

They note that patients who encountered initial insurance denials of DMTs reported that their doctors were often able to obtain coverage by the insurance carriers for the desired treatment. "This highlights the important role physicians play in maintaining patient access to DMTs," they say.

"Action is needed to ensure that all individuals eligible for DMT, including groups for which therapies are newly emerging, such as PPMS [primary progressive MS], are able to benefit from these therapies if they and their physicians deem it to be the best course of action," they state.

New Drugs Have Come at a High Price

In an accompanying editorial, Dennis Bourdette, MD, Veterans Affairs Portland Health Care System, Oregon, and Francesco Patti, MD, University of Catania, Italy, report that 14 different DMTs for MS are now available in the United States.

They say that while the choice of so many drugs allows neurologists to control RRMS in most patients, this has come at a high price, with MS drug costs having "skyrocketed" to an average wholesale price of $65,000 a year.

"In response, insurance companies and specialty pharmacies create restrictions limiting access to these medications, disrupting (or at least, strongly influencing) the care physicians provide their patients with MS," they write.

"US neurologists need to speak out about the unfettered rise of MS DMT prices and the obstacles to care created by insurance companies and specialty pharmacies," they add. "The advancements in the treatment of MS have been remarkable. However, we have much to do in the United States to ensure that all people with RRMS receive the full benefits of the transformational advances in the treatment of MS."

NARCOMS is supported in part by the Consortium of MS Centers (CMSC) and its foundation. This study was supported in part by the Foundation of the CMSC and an unrestricted educational grant by Biogen and by a Don Paty Career Development award from the Multiple Sclerosis Society of Canada and Manitoba Research Chair from Research Manitoba. Disclosures for coauthors appear in the paper. The editorialists have disclosed no relevant financial relationships.

Neurology. Published online June 29, 2016. Abstract Editorial

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