Abstract: Multiple sclerosis (MS) is a chronic disease often causing progressive debilitation for nearly one million Americans. Novel therapies exist that can help slow disease progression and limit new symptoms. Without assistance from support services, MS patients face significant challenges in accessing, affording and adhering to these complex, specialty medications. This report describes major barriers keeping MS patients from needed therapies along with inefficiencies of the traditional model for patient access and support services that suppress enrollment and delay time to therapy. A new technological innovation from CoverMyMeds that solves for these specialty access and support problems is introduced.
Multiple sclerosis (MS) is a progressive disease of the central nervous system that often leads to increasing disability for those affected, which includes nearly one million Americans.1 Research breakthroughs have led to the development of novel therapeutics to alter disease progression and help MS patients manage neurological and physical symptoms.2 Due to their complexity and accompanying high cost, such therapies are often classified as specialty and can be difficult for patients to access.
Despite potential health benefits and availability of these specialty medications, MS patients must often coordinate therapy on their own, which can postpone treatment an average of eight weeks.3 In a recent survey to 507 MS patients, nearly half reported difficulties with medication access and frequently went without treatment in the meantime.3 During such delays, many patients experienced detrimental disease relapses and worsening of symptoms while independently struggling to resolve access issues.4,5
While support services exist to help with medication access, affordability and adherence, patients may not be aware that they exist. In fact, a survey to 10,000 patients across several therapeutic areas found that only 19% of patients, about one of five, were aware of these services.6,7 Drug manufacturers often communicate with health care providers about availability of support services, but studies show that this information does not readily make it to the patient.6,7 Without assistance, patients struggle to navigate challenges associated with specialty medications on their own.
Major Challenges Associated With MS Therapies
Affordability – Out-of-pocket spending for insured MS patients is on average three times higher than for the average consumer.5 Some can spend upwards of $7,000 per year for an MS medication even with insurance.8
Clinical Criteria – Laboratory tests are often necessary before patients can begin MS therapies. For certain medications, risk evaluation and mitigation strategies (REMS) may be required to help limit or manage adverse reactions.9 Scheduling and coordinating transportation for tests can be a burden to MS patients or caregivers.10,11
Enrollment – Support services and financial assistance programs are critical for starting patients on specialty therapies. Knowing the correct enrollment form to use and the right organization to send it to can be unclear and obtaining patient consent for these services can be difficult for health care providers. While enrollment portals are sometimes available, providers can have trouble keeping track of login credentials for multiple medications,12 which may involve different manufacturers, specialty pharmacies and hub providers.
Reimbursement – Benefits investigation/verification (BI/BV) can significantly impact and delay medication access for patients (i.e. reimbursement processes can be different for claims filed under the pharmacy vs. medical benefit of patients’ health plans).13 While important for optimizing utilization of specialty medications, prior authorization (PA) and step therapy requirements can also be difficult for patients and providers to fulfill.3 Research shows that patients are often left to advance these processes on their own, with some MS patients describing it as a full-time job.3,4
Communication – As starting a specialty medication can require information from many different health care stakeholders, knowing who to contact for answers and assistance can be burdensome for patients. Outdated communication channels among stakeholders, including phone calls and faxes, can result in inefficient exchange of critical information that can delay time to therapy and frustrate patients.14
Adherence – Treatments for MS are typically designed for long-term use, but many patients stop taking their medications prematurely.15 Altering dosage, changing insurance coverage, clinical concerns and certain life circumstances can complicate the process for refilling prescriptions and disrupt a patient’s ability to consistently take their medication.15,16 A literature review of MS patient adherence to common treatments revealed adherence rates as low as 41% in some cases.17
Modernizing Specialty Support Services for MS Patients
Support through hub services must be easily accessible and leverage efficiency to improve access, affordability and adherence for patients. The traditional hub model is unable to touch many patients due to enrollment difficulties. For those patients that are enrolled, lack of visibility into progress can cause frustration and manual exchanges among health care stakeholders can delay time to therapy.
Traditional Hub Model
1. Prescription for specialty medication is written.
2. Provider enrolls patient into hub support by logging into one of many specialty portals to manually enter patient information and fill out enrollment form. Alternatively, provider manually fills out paper enrollment form and faxes to hub provider.
*If provider or patient are unaware of support services, access challenges are faced alone.*
- Hub must obtain patient consent for services.
- Provider calls hub to schedule necessary laboratory tests.
- Hub manually completes BI/BV.
- Hub faxes PA request form to provider.
- Provider completes PA request and faxes form to payer.
- Hub calls payer for PA request determination – if the PA request is denied, the provider and hub manually work to appeal and resolve issues.
- Provider contacts laboratory for results.
- Hub calls provider to clear patient for therapy.
- Specialty pharmacy validates prescription and dispenses medication.
Through CoverMyMeds’ new specialty solution and partnership with RxCrossroads by McKesson, patients are enrolled in access and support services at the point-of-prescribing so that all have the opportunity for support. Communication among stakeholders and fulfillment of requirements are electronic, allowing for a more efficient experience for both providers and patients compared to the traditional model.
A New Model for Specialty Access and Support through CoverMyMeds and RxCrossroads by McKesson
1. Prescription for specialty medication is written. If it is an E-prescription, enrollment is automatically triggered within the CoverMyMeds portal for providers that are part of the CoverMyMeds network. If it is a traditional prescription, the provider can still easily start enrollment within the familiar portal.
*The CoverMyMeds portal is already workflow integrated with as many as700,000 providers regularly using it to complete PA requests electronically. In fact, 65% of specialty providers in the neurology therapeutic area have used the CoverMyMeds portal in the last 90 days.<sup>18</sup> When considering only certain centers of excellence in neurology, this number jumps to 94% of specialty providers.<sup>19</sup>*
Patient information is autopopulated on electronic enrollment form. Provider completes and submits form.
– Provider can order services through the enrollment form, including laboratory tests and first dose observation.
– Patient consent for support services is captured in-office or an email is sent to capture consent electronically.
Patients can now be approached for financial assistance programs.
CoverMyMeds helps facilitate scheduling of laboratory tests and first dose observation if needed, uploads test results, helps electronically complete BI/BV and starts an electronic prior authorization request.
Within the online dashboard, providers have visibility into order progress through a status tracker and stakeholders know which steps need completed and know who is responsible. Any complications are fielded through a team of case managers at CoverMyMeds specializing in medication access.
Provider electronically clears patient for therapy within the CoverMyMeds portal.
If the medication requires REMS, CoverMyMeds connects the patient and provider with the appropriate REMS program.
Specialty pharmacy validates prescription and dispenses medication.
A clean script is sent to an appropriate specialty pharmacy within the limited distribution network for the specialty medication.
Automated reminders for refills and on-going support for any coverage or logistical challenges help patients with medication adherence.
Innovative Medicines Need Innovative Health Care Technology
While innovative treatments are available to help manage symptoms and disease progression for MS patients, these specialty medications present patients with distinct challenges. Support services offer patients needed assistance to help access, afford and adhere to their medications. Through innovations in health care IT, inefficiencies of the traditional hub model that limit support for patients and delay time to therapy are being resolved. With a new starting point for specialty medications that is powered by technology, all patients can have the opportunity for effective support on their journeys.
To learn more about how technology is changing the landscape of specialty medication access and beyond, visit go.covermymeds.com/specialty.
- The Prevalence of MS in the United States, Neurology, 2019
- Medications, Treating MS, National Multiple Sclerosis Society
- The Impact of Disease-Modifying Therapy Access Barriers on People with Multiple Sclerosis: Mixed-Methods Study, Journal of Medical Internet Research, 2018
- Make MS Medications Accessible: Recommendations, National Multiple Sclerosis Society
- Access to MS Medications, National Multiple Sclerosis Society, 2018
- Patient Services – Pharma’s Best Kept Secret, Accenture Life Sciences, 2015
- The Patient Is IN – Pharma’s Growing Opportunity in Patient Services, Accenture Life Sciences, 2016
- Trends In Coverage For Disease-Modifying Therapies For Multiple Sclerosis In Medicare Part D, 2019
- Disease Modifying Therapies for MS, National Multiple Sclerosis Society
- Addressing Advanced Care Needs of People with MS and Their Families: The Importance of Education, Prevention, Advocacy and Coordinated Comprehensive Care, National Multiple Sclerosis Society
- Caring for Loved Ones with Advanced MS: A Guide for Families, National Multiple Sclerosis Society
- Simplifying HCP Access to Digital Information, PMLiVE, 2018
- Section 03: Specialty, ePA National Adoption Scorecard, CoverMyMeds, 2019
- Automating Enrollment for Specialty Prescriptions, Point of Care Partners, 2017
- Adherence, National Multiple Sclerosis Society
- Adherence Statistics, Pillsy, 2018
- Narrative Review of the Literature on Adherence to Disease-Modifying Therapies Among Patients with Multiple Sclerosis, 2013
- CoverMyMeds data on file, 2019
- CoverMyMeds data on file, 2019