INDIANAPOLIS—For patients with multiple sclerosis (MS), making treatment decisions is a complex undertaking. The decisions involve clinical factors such as symptom severity, level of disability, and disease duration. Physician recommendations play a major role, but insurance coverage and financial situation also may be factors. Important changes to insurance coverage in the last few years may have required some patients to change their disease-modifying therapies (DMTs) for financial rather than clinical reasons.
To examine this issue, Stacey S. Cofield, PhD, a biostatistician at the University of Alabama at Birmingham, and her colleagues utilized patient-reported data from the NARCOMS registry to describe the insurance status of patient participants and how insurance and financial situation affect their DMT choices. Their findings were reported at the 2015 CMSC Annual Meeting.
The NARCOMS Fall 2014 Update survey included the following questions about health insurance and DMT choices related to insurance: current health insurance (Yes/No), health insurance for the prior six months (Yes/No), comparison of current health insurance to 12 months prior (better, worse, unchanged), and how insurance/financial situation has influenced treatment of MS. Dr. Cofield and colleagues reported on only registry participants who completed the survey online. Data entry for paper forms collected during the Fall 2014 Update is ongoing.
Of the 5,106 participants who completed the survey online, 4,507 (96.9%) completed the health insurance questions, 78.8% were female (mean age 56.7), and 62.1% had relapsing-remitting MS. Nearly all (99.5%) participants had health insurance. Likewise, nearly all (98.6%) had insurance for the prior six months, with 68.6% reporting insurance coverage had not changed in the prior year, while 23.0% reported worse coverage compared to 12 months ago. Coverage did not differ by gender or MS type, but more females reported their insurance coverage to be worse compared to 12 months ago (23.9% vs 19.7%). More respondents with progressive MS reported no change in coverage compared to those with relapsing-remitting MS (73.3% vs 66.8%). When asked about influence of insurance or financial situation on DMT choice, 30.0% reported not taking DMT by choice or physician recommendation, 15.9% took their DMT of choice with full coverage, 46.6% with a co-pay, 19.1% with free/discounted drug program, 3.6% were able to switch DMTs with insurance approval, 1.3% would like to switch but could not due to lack of insurance approval/coverage, while 2.4% had to stop/change/skip DMTs due to higher co-pays, and 1.6% did not take DMTs because they did not have insurance or insurance denied the DMT.
Dr. Cofield reported that most participants in the NARCOMS MS patient registry did not perceive major impacts from their insurance or financial situation with regard to DMT choice. Many patients, however, rely on assistance for DMT coverage or are not able to take a DMT as directed or at all due to their current insurance or financial situation.