OBJECTIVES: To characterize the health insurance coverage in active/nonactive progressive multiple sclerosis (PMS) patients in the US.

METHODS: US physicians who participated in the annual 2016–2021 cross-sectional surveys collected by the Adelphi Disease Specific Programme reported data on their adult patients with active/nonactive PMS. Type of current health insurance and patient cost sharing were described and characterized by patient demographics, diagnosis, and current disease-modifying treatment (DMT).

RESULTS: A total of 2067 patients with active/nonactive PMS were included in the analysis. Mean (standard deviation [SD]) age was 50.7 (10.8) years, and 56.7% were female. Of the health insurances, commercial coverage was the highest for all PMS subtypes (41–51%) and by type of current DMT (52% infusions, 43% orals/injectables, 34% no DMT). Medicare covered ~30% of nonactive PMS, which is slightly higher than the 19–24% of active PMS; 15–17% were covered by Medicaid across subtypes. Of the patients on Medicare (n=568), 36% were on orals/injectables, 23% were on infusions, and 39% were on no DMT. Younger Medicare enrollees (<65 years old) consisted of 65% of the Medicare population, and almost half (49%) had an Expanded Disability Status Scale score ≥5.5, which was similar to Medicare enrollees aged ≥65 years (50%). For patient cost sharing, 67% of patients on orals/injectables, 49% on infusions, and 51% without a DMT paid fixed amounts for their prescriptions. Mean (SD) monthly fixed cost was $52 ($52) for orals/injectables and $61 ($73) for infusions; the percentage of cost was 20% (12%) for orals/injectables and 9% (8%) for infusions. Limited insurance claim denials were reported (3%), which may be due to the study design.

CONCLUSIONS: In this study, commercial coverage was the highest across all PMS subtypes and those with/without DMTs (especially infusions). Medicare was also an important payer, especially for nonactive and younger PMS patients.