How Disease Modifying Therapy Utilization In Multiple Sclerosis Is Influenced by Insurance and Out-Of-Pocket Cost in US Adults: A Summary Of Recent Literature
Author(s)
Divya Jain, Pharm D.;
University of Washington, Student, Seattle, WA, USA
University of Washington, Student, Seattle, WA, USA
Presentation Documents
OBJECTIVES: Sub-optimal adherence to disease-modifying therapies (DMTs) in Multiple Sclerosis (MS) is a well-known issue that has been shown to cause worse patient outcomes and higher healthcare expenditures. How insurance and out-of-pocket (OOP) cost impact DMT utilization has been sparsely and heterogeneously studied. The objective of this targeted literature review was to summarize recent literature on how insurance and OOP cost affect DMT utilization in patients with MS.
METHODS: We conducted a targeted literature review in PubMed and developed a search strategy to identify relevant studies with key inclusion/exclusion criteria: studies that took place after January 2015, studied adult multiple sclerosis populations in the United States, and discussed insurance and/or OOP cost combined with their impact on DMT utilization. Systematic reviews were used as sources for additional studies.
RESULTS: We identified 11 studies that met criteria and reported outcomes including persistence, adherence, utilization, and OOP cost. Patients with commercial insurance had better initiation, adherence and utilization compared to patients with other insurances. Outcomes were reported in utilization rates, days to initiation, odds/hazard ratios and other methods but in general, DMT utilization rates were between 15-20% higher in commercial insurance than public insurances. Higher OOP cost was associated with lower adherence and initiation (OR=0.48 (95% CI (0.29, 0.79))), while cost-sharing delayed initiation and decreased adherence (HR 1.40(95% CI (1.24, 1.57))). Financial assistance, either in the form of drug manufacturer patient assistance programs or grant funding, helped patient adherence (1.9% higher (P = 0.258)).
CONCLUSIONS: Patients with commercial insurance had better utilization of DMTs than patients with public insurance. Policy changes in 2025 may enhance DMT access for Medicare beneficiaries (~ 25-30% of MS patients). Future studies should assess the impact of this policy change on MS DMT utilization and track initiation, adherence and overall utilization improvements.
METHODS: We conducted a targeted literature review in PubMed and developed a search strategy to identify relevant studies with key inclusion/exclusion criteria: studies that took place after January 2015, studied adult multiple sclerosis populations in the United States, and discussed insurance and/or OOP cost combined with their impact on DMT utilization. Systematic reviews were used as sources for additional studies.
RESULTS: We identified 11 studies that met criteria and reported outcomes including persistence, adherence, utilization, and OOP cost. Patients with commercial insurance had better initiation, adherence and utilization compared to patients with other insurances. Outcomes were reported in utilization rates, days to initiation, odds/hazard ratios and other methods but in general, DMT utilization rates were between 15-20% higher in commercial insurance than public insurances. Higher OOP cost was associated with lower adherence and initiation (OR=0.48 (95% CI (0.29, 0.79))), while cost-sharing delayed initiation and decreased adherence (HR 1.40(95% CI (1.24, 1.57))). Financial assistance, either in the form of drug manufacturer patient assistance programs or grant funding, helped patient adherence (1.9% higher (P = 0.258)).
CONCLUSIONS: Patients with commercial insurance had better utilization of DMTs than patients with public insurance. Policy changes in 2025 may enhance DMT access for Medicare beneficiaries (~ 25-30% of MS patients). Future studies should assess the impact of this policy change on MS DMT utilization and track initiation, adherence and overall utilization improvements.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
PCR217
Topic
Patient-Centered Research
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)