New Study Shows Out-Of-Pocket Costs Hamper MS Patient Treatments

A new study conducted by pharmacy benefits manager Prime Therapeutics found out that the high out-of-pocket costs are making one out of four MS patients fail to fill out their proscription forms. The study found out that MS patients dealing with out-of-pocket expenses amounting to more than $250 are around seven times more likely not to fill out prescription forms for their condition as compared to MS patients with out-of-pocket costs of $100 or less.

According to Patrick Gleason, PharmD, FCCP, BCPS, the lead author and Director of Clinical Outcomes Assessment at Prime Therapeutics, "Our research suggests members who pay high out-of-pocket costs are declining to fill their prescription. Patients who aren’t taking their medications face serious medical and health complications, which could result in substantial medical or hospitalization expenses for both the patient and health insurer. Health insurers should consider member cost and the impact it has on adherence when designing specialty pharmacy benefits."

Specialty medications for multiple sclerosis have an average wholesale price of $2,500 for a month’s supply, which translates to an expense of $30,000 yearly. In order to best manage costs due to the rising prices for specialty medicines, more and more insurers are trying to increase out-of-pocket costs for members. But this might eventually lead to a significant effect on patients in terms of patient care and health care costs by avoiding necessary medication for conditions such as MS.

Prime Therapeutics designed a study to determine whether there is an association between patients declining to fill up their prescription forms and out-of-pocket expenses. The study considered cases of members as "declined to fill" when reversed claim for a certain MS specialty medication result in no paid claims for that same medication during the next 90 days. The study covered seven million members included in the database of eight commercial Blue Cross and Blue Shield plans who presented a new MS prescription that required filling up at a pharmacy.


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