Action Is Needed: Costs Limit MS Patients’ Access to DMTs

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MS and DMTs

A recent survey of more than 6,000 multiple sclerosis patients in the United States found that health insurance coverage can decide their access to disease-modifying therapies (DMTs), and that that coverage is worsening, leaving a good number struggling to be able to pay for their treatment.

As an MS patient myself, I find that absolutely shocking.

The survey itself was carried out in 2014, but there seems little doubt that the situation has only continued to worsen over the last two years. Some patients do not take DMTs for financial reasons, or skip doses to cut costs, the survey also found.

A stark warning came from its authors: “If the costs of disease-modifying therapies continue to rise as they have over the last five years, we can expect that they will become unattainable for many individuals with MS.”

Depriving chronically sick people of essential medications is wrong, anyway you look at it. And to do so by denying or restricting coverage because of a treatment’s price tag, in my opinion, is a terrible indictment of the insurance industry, of the U.S. government for failing to control prices or ensure coverage, and of the pharmaceutical industry — which opens a backdoor to people by offering free or reduced access to some DMTs, especially newer ones, but keeps the prices of those same drugs prohibitively high.

The survey, “Health Insurance Affects the Use of Disease-Modifying Therapy in Multiple Sclerosis,” and published online in Neurology on June 29, was conducted by a team led by Guoqiao Wang, PhD, at the University of Alabama at Birmingham. It included 6,662 people with MS who were active members of the North American Research Committee on MS (NARCOMS), a voluntary self-reporting registry.

Action is needed to open access to DMTs

I am not going to get into the report’s gritty details, you can find those by following the link given above, or by reading coverage given it in Multiple Sclerosis News Today.  I shall just comment from a patient’s perspective.

In general terms, nearly all patients reported having some form of medical insurance, with most having only private insurance and others either public insurance, a combination of private and public, or public insurance with a supplemental.

While most reported that their health insurance had not changed from the preceding year, a significant proportion (22.1%) reported that their coverage had worsened, with a small but disturbing number of respondents experiencing some obstacle to coverage for a given DMT, either outright denial of coverage (3.3%) or denial in switching from one DMT to another (2.3%). In the pharmaceutical industry’s favor, the survey notes that almost one-quarter of respondents were using company-supported, free or reduced price drug programs to acquire their medications.

“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,” the authors wrote.

They suggest that these negative effects likely reflect both the dramatically increased cost of the drugs and the response to those high costs by insurance carriers. Well, of course they do!

The authors continue: “Action is needed to ensure that all individuals eligible for DMT, including groups for which therapies are newly emerging, such as primary progressive MS, are able to benefit from these therapies if they and their physicians deem it to be the best course of action.”

I agree, and such action needs to be taken now. For any patient to be continue to endure this situation is simply unacceptable.

Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this blog article are not those of Multiple Sclerosis News Today, or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Multiple Sclerosis. 

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Ian Franks is Managing Editor of the Columns division of BioNews Services. He has enjoyed a successful career as a journalist, from reporter to editor, in the print media; during which he gained a Journalist of the Year award in his native UK. He was diagnosed with MS in 2002 but continued working until mobility problems forced him to retire early in late 2006. He now lives in the south of Spain and uses his skills to write his own flourishing specialist MS, Health & Disability blog at Besides MS, Ian is also able to write about both epilepsy and cardiovascular matters from a patient’s perspective and is a keen advocate on mobility and accessibility issues.
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One comment

  1. Amy says:

    Medical groups are also taking their piece of the pie. In Columbus ohio, a health group closed infusion centers saying you needed to go to their locally owned hospital. Cost of tysabri infusion changed from $9000 to $27000. I can give you details and names

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