Dr JT Lew Explores the Barriers to MS Medication Access

JT Lew, PharmD, MBA

At The American Journal of Managed Care^®’s Institute for Value-Based Medicine (IVBM) event in Seattle, Washington, cohosted with Providence, JT Lew, PharmD, MBA, a managed care pharmacist at MultiCare Health System, presented on the challenges regarding medication accessibility in the multiple sclerosis (MS) treatment space.

The IVBM highlighted integrative approaches in neuroscience population health, with additional presentations on the Alzheimer disease landscape, nonopioid pain management, and the impact of biosimilar market expansion.

This interview was edited for clarity.

What are the primary challenges faced by patients with MS in accessing their prescribed medications?

Lew: I'd say the main challenge, I think of is information overload for patients, especially with next steps. When getting diagnosed with multiple sclerosis, it's a shock value. It's not really a diagnosis that patients often anticipate having in their lifetime.

For example, I might have some lifestyle habits that might not be so great, or family history saying that I might be at risk for developing something like hypertension, diabetes—so I have that on my radar—but multiple sclerosis, given its severity and scarcity in the country, let alone all over the world, many patients can't prepare for it. So, with that, there comes the initial shock value of the diagnosis.

And then, here are all your costs associated with your medications to help prevent your disease from progressing further. When I go into my open enrollment, that's not something I necessarily think about. "Oh, I'm going to get diagnosed with multiple sclerosis." So, understanding the ins and outs of the current benefit design of the health plan that they signed up for is also incredibly challenging. Patients are saying, "Wait, where are all these out-of-pocket costs coming from? Why do I have a co-insurance?" And when they talk to different patients, they say, "Oh, I'm commercially insured. I got a manufacturer co-pay to use for my medication." So that helps mitigate one of the challenges of those out-of-pocket costs. But patients who might be retired, for example, and on Medicare, they can't use those manufactured co-pays then. It's like, "What do I do? That's a big challenge. How do I scrounge up the money to pay for my expected cost share on my current Medicare plan?"

The other thing too is the turnaround time with how quickly they can receive these medications. Often, we encourage patients to start medications early to help reduce the risk of disease progression. However, they do cost a lot for insurance plans, so therefore, they are often safeguards or utilization management tools, like prior authorizations or step therapies, where you have to have some sort of pre-approval process that takes time from expert clinicians or reviewers to determine whether the patient meets criteria to be able to receive the medication.

So those are also challenges—that waiting period for the patient and the concern that, "Well, they told me, I need to get on this medication early, but I can't get it." So that can also instill some fear and challenges in patients in such a sensitive population. So those are the few, those are the few challenges that I see, at least, within managed care and I'm sure there's other clinicians out there who see a lot of other challenges too, so don't want to discount their opinions too.