Biotechnology Healthcare - September/October 2008 - (Page 29)

MANAGING MS Trends, Issues, and Perspectives A new report identifying trends in MCO management of multiple sclerosis also identifies gaps that could hinder the care of MS patients. Stakeholders say the nature of MS and its treatment offer collaboration opportunities that can help to close those gaps. BY MARI EDLIN n managing the care of members with multiple sclerosis, MCOs use many of the same tools they employ to manage the care of people with other chronic illnesses. But in some respects, the nature of MS and its treatment differ from other chronic conditions where biologics are commonly part of the treatment mix — enough so to foster opportunities for stakeholder collaboration that can facilitate high-quality, cost-effective care. That’s the take of several experts following the release of the Multiple Sclerosis Report: Perspectives from Managed Care, Providers, and Patients. The report, sponsored by Teva Neuroscience and the National Multiple Sclerosis Society (NMSS), examines current trends in managing MS, including treatment, re- I Figure 1 Strategies for managing MS therapies MCOs were asked: Indicate for each of the following how soon your organization will adopt various benefit design strategies to deal with relatively expensive biotech-derived MS products. Will not do Currently doing 50 Will do within the next 12–18 months 22 27 Increase annual out-of-pocket maximums Limit product prescriptions only to the appropriate specialties Introduce a separate benefit design just for specialty therapies Require prior failure on a formulary-preferred product before approving use of a nonpreferred product Establish lifetime caps for injectable or specialty products Enforce strict laboratory value thresholds (hemoglobin A1c, C-reactive protein, etc.) as a prerequisite for product access Use differential prior authorization rules to direct physicians to a preferred agent within a category Create tiered coverage with significant cost-sharing differentials (>$30) between preferred and nonpreferred therapies Create tiered coverage without significant cost-sharing diferentials, but with strict prior authorization rules governing access to nonpreferred therapies 75 44 18 59 23 16 39 9 69 22 12 12 29 40 30 20 45 35 26 32 42 38 29 32 Data in all figures and the table in this article are from the Multiple Sclerosis Report: Perspectives from Managed Care, Providers, and Patients, 2008 SEPTEMBER/OCTOBER 2008 · BIOTECHNOLOGY HEALTHCARE 29

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - September/October 2008

Biotechnology Healthcare - September/October 2008 Openers Editorial/David B. Nash, MD, MBA Contents At a Glance: Multiple Sclerosis Drug Track Personalized Medicine Healthcare Reform’s Effects on Biologic Access Breast Cancer Status Testing: A Crapshoot With Deadly Odds Trends, Issues, and Perspectives In the Management of MS So High-Tech, Yet So Simple The Evolution of Ascertaining the Value Proposition Specialty Pharmacy Employer to Employer Health Plan Confidential Trends

Biotechnology Healthcare - September/October 2008

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