Managed Care Strategies for Multiple Sclerosis

San Diego—In the United States, approximately 400,000 people have multiple sclerosis (MS). Each day, there are approximately 200 new diagnoses of the disease, presenting a burden on patients who typically live with MS for 20 to 40 years as well as the healthcare system that has to treat the chronic, costly condition.

For most companies, MS is the second most expensive specialty category, costing approximately $40 per member per year, according to Douglas Burgoyne, PharmD, president of VRx Pharmacy Services, LLC, in Salt Lake City, Utah. The lifetime cost per patient is approximately $4.1 million.

At the AMCP meeting, Dr. Burgoyne and other speakers said several recent FDA approvals have led to more treatment options for MS, but managing the disease remains a challenge. They discussed the new drugs and how to best utilize managed care principles in a Satellite Symposium titled Personalizing Patient-Centric Care for Multiple Sclerosis: The Role of Managed Care Pharmacy. The symposium was supported by an educational grant from Novartis AG and Teva Pharmaceutical Industries Ltd.

Dr. Burgoyne said typical managed care strategies for MS include prior authorizations, step edits, cost sharing, preferred products, case management, and cost-effectiveness analysis. In addition, if patients have difficulty paying for the drugs, manufacturers typically offer financial assistance.

Bruce Hughes, MD, director of the MS center at Mercy Medical Center in Des Moines, Iowa, said there were no FDA-approved drugs for MS 20 years ago. Now, there are several, including 3 oral agents: (1) Gilenya^® (fingolimod), (2) Aubagio^® (teriflunomide), and (3) Tecfidera^TM (dimethyl fumarate).

Still, most physicians use injectable drugs as first-line therapies in treating MS because they have long-term safety data available. Many patients prefer oral drugs, but they are new and have not been tested in long-term studies. There are several other drugs in late-stage development, including alemtuzumab from Genzyme, which Dr. Hughes said could be approved this year.

Dr. Hughes said oral drugs will be used more in the future and added that Biogen Idec, manufacturer of dimethyl fumarate, is focusing on that drug rather than its older, FDA-approved injectable products.

“We can hem, haw, and talk,” Dr. Hughes said. “Patients are going to want pills.”

Even as the therapeutic options expand, the costs to treat MS will continue to increase. Dr. Hughes remarked that “healthcare is the only industry where you have more competition and the prices go up.”

Gary Rice, RPh, vice president of clinical services at Diplomat Specialty Pharmacy in Flint, Michigan, offered a few suggestions on how to achieve cost savings. He said the most effective strategy is through drug therapy and channel management. His other ideas included implementing prior authorization, step edits, and preferred drugs, and negotiating better discounts on the average wholesale price of drugs.

Dr. Rice said specialty pharmacies can help payers by assisting with clinical reviews, providing channel management support, collecting information on appropriate use of medications, and lowering administrative costs. He added that a 2009 study found the average cost of a relapse was $4682, which demonstrated the need to maintain close contact with and monitor MS patients. Dr. Rice also suggested healthcare professionals understand that >50% of patients with MS will develop depression, which leads to a significant decrease in their quality of life.