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Kansas City, Mo. (March 3, 2011) – New treatments for multiple sclerosis (MS) are creating challenges for managed care organizations (MCOs), pharmacy benefits managers (PBMs)/specialty pharmacy (SP) executives and neurologists. According to the National Institute of Allergy and Infectious Diseases, one in 700 people in the United States is affected by MS. Like many rare disorders treated with orphan drugs, MS combines a relatively low prevalence with disproportionate costs of care. To manage costs, as many as 76% of managed care plans use specialty pharmacy providers to deliver MS drugs, 29% of which mandate their use, according to The Multiple Sclerosis Trend Report 2nd Edition. These findings are a few of many received from respondents in a survey sponsored by Teva Neuroscience and the National Multiple Sclerosis Society.
MCOs, PBMs/SPs and neurologists detail their practices and express their opinions about preferred and emerging therapies for MS; criteria for covering these drugs; cost and utilization management tools, such as prior authorization and step therapy; benefit design and formularies; therapy goals; and patterns of medication prescribing.
In addition, The Multiple Sclerosis Trend Report 2nd Edition captures insights from a roundtable of employers about the impact of MS on productivity; benefit design; the role of education; and use of cost management tools. The report also delves into the personal stories of MS patients–the symptoms that led them to seek medical attention, the decision of which treatment to use, and how they live day-to-day with the disease.
"The high cost of MS drugs has made managing the condition a priority for many managed care organizations," says Nicholas G. LaRocca, Vice President of Health Care Delivery and Policy Research at the National MS Society. "The recent approvals of oral therapies, such as Ampyra to improve the function of walking in MS patients and Gilenya as a disease-modifying treatment option, will pose both opportunities and challenges. While oral therapies may impact drug adherence due to ease-of-use, their long-term safety and efficacy have not been established over time and, therefore, are still unknown. This, as well as higher cost, may deter use of these medications by some MCOs, neurologists and PBMs. Inevitably, these new oral medications will have a bearing on benefit design and coverage."
Report Results
Highlights of The Multiple Sclerosis Trend Report 2nd Edition, in which 304 representatives from the MCO, PBM/SP and provider groups were surveyed, include:
- An overwhelming majority of MCOs cover the self-injectable MS therapies–Avonex® (interferon beta-1a IM), Betaseron® (interferon beta-1b SC), COPAXONE® (glatiramer acetate injection), Rebif® (interferon beta-1a SC) and Extavia® (interferon beta-1b SC)–under the pharmacy benefit. Tysabri® (natalizumab), an infused product, most often falls under the medical benefit. When managed care respondents were asked what restrictions they set for covering the six available immunomodulators, prior authorization takes precedence.
- PBMs/SPs said that 70% of their MCO clients mandate use of specialty pharmacy providers for MS immunomodulators always or frequently. About one-fifth said the use of specialty pharmacies is sometimes required, while 4% said a specialty pharmacy is never required for dispensing these drugs.
- The majority of MCOs, PBMs/SPs and neurologists reported that COPAXONE® is prescribed more frequently than other disease-modifying therapies.
- Among the value-added pharmacy-related programs that specialty pharmacies and PBMs provide to MCOs, patient education ranked the highest (90%), followed by refill reminders (86%), patient assessment prior to shipment of medications (65%), and billing and collections (53%).
- Survey results suggested that many patients may not be reaching important treatment goals. For example, only one in three neurologists said that more than 75% of their patients attained the therapeutic goal of preventing relapses after one year of treatment. Carrá and colleagues1 found that switching to an agent with a different mechanism of action produced a mean reduction in relapse rates between 67% and 77%.
- Sixty-one percent of MCO respondents said they do not place a moratorium on a new molecular entity before initiating coverage. Most plans (71%) that do establish a moratorium on new drugs wait six months before covering the drug.
- When MCOs were asked about the effect of head-to-head studies on formulary placement, 15% of respondents said they use them in their decision-making process, and 42% said they were unaware of study results.
COPAXONE® (glatiramer acetate injection) is indicated for reduction of relapses in patients with relapsing-remitting multiple sclerosis, including patients who have experienced a first clinical episode and have MRI features consistent with multiple sclerosis.
Important Safety Information
Most common adverse effects were injection site reactions (including lipoatrophy and, rarely, skin necrosis), vasodilatation, rash, dyspnea, and chest pain. Patients should be advised to follow proper injection technique and to rotate injection sites daily.
About 16% of patients experienced an immediate postinjection reaction (flushing, chest pain, palpitations, anxiety, dyspnea, throat constriction, and urticaria). The symptoms were transient and self-limited, and did not require specific treatment.
Transient chest pain was noted in 13% of COPAXONE® patients (vs 6% placebo); no long-term sequelae.
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Teva Neuroscience
Headquartered in Kansas City, Mo., Teva Neuroscience, is dedicated to the investigation and development of products and services in the area of neurology, with an emphasis on MS and Parkinson's Disease.
The National Multiple Sclerosis Society
The Society helps people affected by MS by funding cutting-edge research, driving change through advocacy, facilitating professional education and providing programs and services that help people with MS and their families move their lives forward. The Society has a network of chapters in all 50 states that provide programs and services to more than a million people annually. For more information about MS and the work of the Society visit http://www.nationalMSsociety.org.
To order a copy of The Multiple Sclerosis Trend Report 2nd Edition, visit http://mstrendreport.com.
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