Segment 7: MS Therapies: Insurers Putting Up Roadblocks

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There is a goal in the multiple sclerosis (MS) community to develop a consensus-based treatment algorithm, explains Fred Lublin, MD. It would be welcomed not only by physicians, but by payers and insurance companies. However, Lublin does not believe that such an algorithm can be easily developed, gbecause the available MS medications vary so greatly in administration and mechanism of action and have different safety profiles and contraindications. He explains that neurologists must decide on the optimal therapy jointly with the patient and family.

With the recent additions of oral agents, insurers now realize that MS is a fairly costly chronic disease. Coyle states that The MS Coalition published an update of their treatment guidelines, and they clearly re-endorsed the concept that all the disease-modifying therapies (DMTs) should be available for relapsing forms of MS. However, she comments that insurers are increasingly setting up roadblocks, such as tiered drug plans, that make it difficult to treat patients with the optimal individualized therapy.

Coyle describes a study from United Kingdom that was borne out of cynicism about the cost of the DMTs versus their cost-effectiveness. Six years into a required 10-year extension, researchers found that by every parameter, DMTs demonstrated their cost-effectiveness. She explains that even with the expense of DMTs, treatment reduces disability and allows patients to lead normal productive lives, and thus “It is cost-effective to society.” These data help support the position that neurologists should be able to select the best treatment for each patient without limitations from insurers and payers.