Autoimmune Diseases: Multiple Sclerosis

The final installment of this 3-part First Report Managed Care Trends Report reports the findings from survey participants on multiple sclerosis (MS). 

Data for this sixth edition of Trends Report was generated through a comprehensive survey of managed care professionals. Survey questions were developed by the editorial staff and vetted by 9 members of the Editorial Advisory Board. The types of questions asked in the survey focused on treatment guidelines, compliance and adherence measures, prior authorization criteria, and treatment decisions for some drug classes used in the management of autoimmune diseases. Additionally, the survey participants were asked to provide comments on the challenges of treating autoimmune diseases from a managed care perspective.

The survey was distributed via a recognized survey platform and sent to the universe of managed care professionals from our email database. A total of 39 managed care professionals completed the survey with 11 partial completions. Data was then compiled based on all of the participants to generate this report.

For the survey participant demographic data, 93.9% said their organization has responsibility for commercial insurance plans. Based on the lives covered, in which 24.5% of the survey participants said >5,000,000 lives are covered by their plan; 34.0% said the most common commercial formulary has 3 tiers; and 30.0% said their most common Medicare formulary has 3 tiers. In terms of their primary formulary being open or closed, 40.0% of those who participated in the survey said closed, while 34.0% said open with selected exclusions, and 20.0% said open.

For complete demographic information, please see the September issue.

The complete Trends Report will be available for download on Managed Health Care Connect at www.managedhealthcareconnect.com/supplements. 

Multiple Sclerosis

MS is a chronic, inflammatory disease of unknown etiology that involves an immune-mediated attack of the central nervous system (CNS).¹ Individuals with MS have a disabled CNS that interrupts the flow of information within the brain and between the brain and the body, causing nerve impulses throughout the body to be distorted or interrupted.¹ Four disease patterns have been identified in MS: relapsing-remitting MS (RRMS), primary-progressive MS, secondary-progressive MS, and progressive-relapsing MS. The most common pattern of the disease is RRMS, which affects approximately 85% of individuals with MS.² While the disease is not contagious or directly inheritable, it is thought to affect approximately 2.5 million people worldwide.²

No cure yet exists for MS, and treating MS is a balancing act between fighting the immune response and allowing the immune system to continue to defend the body. Individuals with MS will require disease-modifying therapies (DMTs) to alleviate symptoms and manage exacerbations. DMTs for the treatment of relapsing forms of MS include injectable therapies, newer oral therapies, and monoclonal antibodies.^2,3

Survey Results

The survey participants were evenly split in their response to whether their organization currently has treatment guidelines in place for the treatment of MS—50.0% said “yes” and 50.0% said “no.” In a follow-up question on MS guidelines, the survey participants were asked if these guidelines are based on national guidelines from professional organizations, developed internally, or developed by their pharmacy benefit manager (PBM). More than one-quarter of the survey respondents (27.5%) said these guidelines are based on a combination of internally- and nationally-developed guidelines, while 12.5% said they are based on national guidelines from professional organizations and another 12.5% said the guidelines are developed by their PBM. See Figure 1. 

The majority of the survey participants (70.0%) said “yes” when asked if their organization currently has prior authorization screening criteria for access to specialty pharmacy drugs for the treatment of MS. 

Compliance with therapy is the key for favorable outcomes for patients with MS.² Therefore, the survey participants were asked about their organization’s involvement in reporting adherence/compliance on the use of MS medications obtained through through a specialty pharmacy, 37.5% said “a moderate amount” and 22.5% said “a great deal.” Another 20.0% said “never.” See Figure 2.

Because some specialty pharmaceuticals used in the treatment of MS requires in-office administration of the drug, the survey participants were asked to select a percentage range that best represents their organization, and 37.5% of the participants said 0% to 25%. Another 15.0% of the survey participants said 26% to 50%. See Figure 3.

Continuing with the topic of medications for MS, the survey participants were asked if they are seeing an increase in the utilization and prescribing of oral MS medications, such as teriflunomide (Aubagio), fingolimod (Gilenya), and dimethyl fumarate (Tecfidera) over the past 12 months, and 40.0% said “yes” and 25.0% said “no.” 

There is growing evidence that earlier treatment of MS can prevent progression and associated medical cost.4 The survey participants were asked if they are seeing providers treat the disease earlier now, and more than half of those surveyed (55.0%) said “yes.” 

Conclusion 

MS is a chronic, progressive, neurologic disorder that requires lifelong treatment with DMTs.² Yet, 50% of survey participants reported that their organizations do not have treatment guidelines in place to treat MS. Compliance and adherence measures are important components in evaluating MS therapies. However, 20.0% of survey respondents reported their organization is “never” involved in reporting adherence/compliance on medications obtained through a specialty pharmacy. One survey respondent, a vice president of medical management, noted the need for increased patient compliance, according to the open-ended section of the survey in which respondents were asked to share their general thoughts and concerns regarding MS. While some specialty pharmaceuticals for MS treatment, such as glatiramer acetate (Copaxone), requires in-office administration, more than one-third of survey respondents (35.0%) said they were not sure what percentage of specialty pharmaceuticals for MS requires in-office administration. Despite evidence4 that earlier treatment of MS can prevent disease progression, almost thirty percent of survey respondents (27.5%) reported that they were not sure if providers are treating the disease earlier. The availability of increasing DMTs has provided patients and clinicians with a multiplicity of therapeutic options for MS. However, the lack of comparative effectiveness data on newer MS therapies, cost of treatment, and no single go-to treatment algorithm add to the complexity in managing and treating this disease state.

REFERENCES

1. About MS. National Multiple Sclerosis Society website. https://www.nationalmssociety.org/For-Professionals/Clinical-Care/About-MS. Accessed October 5, 2016.

2. Habbi M, Kuttab HM. Management of multiple sclerosis and the integration of related specialty pharmacy programs within health systems. Am J Health Syst Pharm. 2016;73(11):811-819.

3. Carrithers MD. Update on disease-modifying treatments for multiple sclerosis. Clin Ther. 2014;36(12):1938-1945.

4. Ziemssen T, Derfuss T, de Stefano N, et al. Optimizing treatment success in multiple sclerosis. J Neurol. 2016;263(6):1053-1065.