AAN 2026: Top-tier MS drugs out of reach for many on Medicaid
Wide variation across state plans highlights coverage inequities
Written by |
A health insurance claim form gives options for type of insurance.
- Medicaid coverage for high-efficacy therapies varies widely by state.
- Many state Medicaid plans offer no access to these critical MS treatments.
- Managed care plans show lower access to MS therapies than fee-for-service plans.
Medicaid coverage of highly effective disease-modifying therapies (DMTs) for multiple sclerosis (MS) varies across the U.S., with some states offering no access at all, a study reported.
The research suggests that where a person lives could influence whether they receive high-efficacy therapies, which are known to better control disease activity and slow disability progression.
Mihir Kakara, MD, a neurologist at New York University Langone, presented the study’s findings at the American Academy of Neurology 2026 annual meeting, held April 18–22 in Chicago and online.
“I think this wide variation [in Medicaid coverage and utilization] may explain a few of the health inequities that we see in patients who have MS,” Kakara said in his oral presentation, titled “Access to High-efficacy Therapies for Multiple Sclerosis Under Medicaid: Variation in Coverage and Utilization Across States.”
More than 20 DMTs are approved in the U.S. to treat relapsing forms of MS, but not all offer the same level of benefit. High-efficacy therapies have been shown to more effectively reduce relapses and delay disability progression, particularly when used early in the disease course.
Exploring inequities in care
“We have learned that early initiation of high-efficacy treatments is important and can improve long-term outcomes,” Kakara said.
However, these therapies may not be accessible to everyone. Prior studies have shown that race, socioeconomic status, and geography can all influence whether patients receive high-efficacy treatments, raising concerns about inequities in MS care.
To better understand the role of insurance, Kakara and his colleagues analyzed coverage across 462 Medicaid plans in 2024, spanning all 50 states and Washington, D.C. Medicaid is a government-sponsored insurance program for low-income individuals and people with disabilities, covering an estimated 80 million-90 million Americans.
Most plans were managed care organizations (MCOs), which are run by private insurers under state contracts. The rest were fee-for-service (FFS) plans administered directly by state governments.
The researchers defined high-efficacy therapies as CD20 inhibitors — including Briumvi (ublituximab-xiiy), Kesimpta (ofatumumab), Ocrevus (ocrelizumab), and Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq) — and Tysabri (natalizumab).
They found 41.8% of plans did not cover any of these high-efficacy therapies, and 43.7% did not cover any CD20 inhibitors.
Fewer than one in four plans offered at least two high-efficacy therapies with preferred status. These are therapies that do not require prior authorization from the insurer, making them easier for patients to access.
Kakara said having multiple preferred options “is important, because not all high-efficacy treatments are equal.” Some patients may not be eligible for certain therapies, while others may prefer a specific method of delivery or a specific dosing frequency, he said.
The researchers found substantial variability in coverage of high-efficacy therapies across states. In nine states — California, Illinois, Iowa, Kansas, Kentucky, Minnesota, New Mexico, South Dakota, and Tennessee — none of the analyzed Medicaid plans covered any high-efficacy therapies.
MCO and FFS plans also had some differences in terms of coverage. While 70% of FFS plans included at least one high-efficacy therapy, only 58.7% of MCO plans did the same.
In a model that accounted for state, patients enrolled in MCO plans had about an 18% lower likelihood of using high-efficacy therapies than those in FFS plans, who used them at significantly higher rates.
“I think there’s more work to do for us and for insurers as well,” he said. “Trying to achieve equity would mean making sure all MCO plans [and] FFS plans include all high efficacy drugs at the same level.”
In addition to plan coverage, the team assessed how Medicaid enrollees used high-efficacy medications in 2024. On average, patients on Medicaid spent about 63 of every 100 treatment days on high-efficacy therapies, “which is pretty good,” Kakara said. However, he added, this also varied widely across states.
Kakara and his team plan to look for associations between coverage and utilization. This will allow them to determine how Medicare coverage of high-efficacy therapies affects their real-world use.
Leave a comment
Fill in the required fields to post. Your email address will not be published.