OBJECTIVES : Describe baseline characteristics and disease-modifying therapy (DMT) patterns among patients with multiple sclerosis (MS) in Puerto Rico (PR), using a geographical region model.

METHODS : In 2015, the Plan de Salud del Gobierno (PSG) or ‘Government Health Plan’ defined 8 geographical regions servicing PR patients. This retrospective, observational study assessed the Special Care Pharmacy Services database for demographics, insurance coverage, and DMT type (oral, injectable, infusible) in MS patients in PR between 2010 and 2016, using PSG geographical region model. Demographic data were collected at the most recent DMT prescription; treatment modality information was obtained from all claims between 2013 and 2016. Average weekly income for each region was documented.

RESULTS : Of 2068 MS patients (mean age, 44.8 years; 75.6% female), 12% were from the San Juan region, 21% from the surrounding North Metro region, and 67% from other regions. Average weekly income between regions ranged from $361 (West) to >$600 (San Juan). Insurance coverage trends were related to region-specific average weekly income; highest proportions of commercially insured, Medicaid, and Medicare MS patients were from the San Juan (44.8%), Southeast (48.4%), and West (37.7%) regions, respectively. Across all regions, 15.1%–24.8% of DMT claims were for oral DMTs and 22.2%–35.6% were for subcutaneous DMTs. The highest proportions of intravenous DMT claims were from the higher average weekly income regions (San Juan [38.7%] and surrounding North Metro [46.7%]). Conversely, the region with lowest weekly income (West) had only 8.7% of claims for intravenous DMTs versus 43.9% for intramuscular DMTs.

CONCLUSIONS : Despite the availability of novel and more efficacious MS therapies, many patients in PR remain on injectable medications. Differences between regions are possibly due to formulary restrictions from commercial insurers, disparities in coverage between commercial insurance, Medicaid, and Medicare plans, and access to treatment options in regional health care centers.