Is Your Drug Plan the Best One for You?

Ed Tobias avatar

by Ed Tobias |

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MS medications survey


It’s that time of the year. Drug insurance companies in the U.S. are making changes to their formularies — the list of drugs that your insurance company will pay for. Those formularies change from year to year so you need to be alert to changes that may impact your drug costs.

One insurance company adds several MS drugs

As I checked my coverage list for 2017 I was surprised to read that UnitedHealthcare, one of the nation’s top three health insurers, plans to add several multiple sclerosis drugs to its coverage. According to the pharmaceutical newsletter FiercePharma, “some drugs — such as multiple sclerosis treatments from Novartis, Sanofi and Biogen — will get a boost. Seven MS drugs that were previously excluded — as was Biogen’s Plegridy — or otherwise restricted will be freely available. These include Biogen’s Tecfidera, Novartis’s Gilenya and Sanofi’s Aubagio, three of the new generation of oral treatments.”

On the other side of the coin…

UnitedHealthcare and some other insurance companies are also reducing the number of drugs they’ll cover for some other medical problems. These include the insulin drug Lantus and Neupogen, which fights inflections. FiercePharma reports that the reasoning behind these changes appears to be two-fold. First, more biosimilar drugs are coming onto the market. These are FDA-approved drugs that are highly similar to the original drug but they’re made from living organisms. So, they’re less expensive.

Second, some insurance companies seem to feel that some drugs (such as the painkiller OxyContin) are being over-prescribed due to aggressive marketing by the drug makers.

Finding the best drug plan

If your drug insurance is private you’ll probably have to go to the web sites of individual insurance companies to compare formularies and your out-of-pocket costs. Medicare patients, however, can enter their state and their drug names to compare plans on the Medicare website. There’s a short window for Medicare patients to change their drug plans: Oct. 15 to Dec. 7, so now’s the time to begin your research.

MS Society starts campaign to get patients their meds

At about the time that I was reading about the UHC changes, an email dropped into my inbox from the National Multiple Sclerosis Society in the U.S. It’s launching a campaign called “Make MS Medications Available.” The MS Society is hoping to rally MS patients, drug companies, benefit managers, healthcare providers, lawmakers, and others to support recommendations that, the group says, would give MS patients affordable meds, easy to access to them and the information they need to make good medication choices. The full plan is outlined in a 15-page document, ending with several specific recommendations for each stakeholder.

Much of this campaign is aimed at elected officials, and it includes asking candidates running in the upcoming November elections to take a pledge to ensure that “access to life-changing medications is affordable, simple and transparent.”

As is written on the MS Society web site: “Each of us has an important role in making sure people get the medications they need to live their best lives.”

How true. I hope you’ll do what you can to support the “Make MS Medications Available” program.

(You can read more of my columns on my personal website:

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 column 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.


Mary Holmstrand avatar

Mary Holmstrand

Are you f*** kidding me! Where is the campaign to make "HSCT avaialabe for MS patients"? I am so sick of catering to the drug companies! Come on people!!! Oh, right, its an approved "procedure" and not a drug!!! Get more informed please and write about HSCT as a campaign!

Ed Tobias avatar

Ed Tobias

Thanks for your comment, Mary. I agree with you that more should be done to push for approval of HSCT, not just for folks with MS but for all patients who might benefit from it. But I still have to applaud the National MS Society for trying to form a coalition to try to lower the cost of those treatments that ARE available right now. And those treatments are very expensive drugs.

May I suggest that a better place to express your opinion about an HSCT campaign is on the MS Society's blog: There it will be seen by the people who could make that campaign a reality.



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