Biotechnology Healthcare - September/October 2008 - (Page 32)

Figure 3 Management of unproven MS therapies MCOs were asked: What action(s) is/are appropriate to manage the use of an injectable biologic for which long-term efficacy has not yet been established? Ensure that patient has failed (i.e., side effects or no efficacy) conventional therapy Ensure that patient has been compliant with conventional therapy Encourage patient to use a preferred biologic agent within the class category 85 67 60 Allow use if physician prescribed it 7 patient and cost-effectiveness in the use of healthcare resources.” GAPS IN MANAGING MS Although enthusiasm for collaboration among stakeholders is growing, there are still gaps in managing the care of patients with MS. Because MS is not highly prevalent in the overall population, less than 10 percent of MCOs surveyed said they offer fully developed disease management programs that in corporate reporting and clinicaloutcome tracking capabilities. Another 27 percent do not even track absolute numbers of members who have MS. LaRocca views this as an unmet need that is ripe for development — considering that more than two thirds of MCOs agreed that a disease management program for MS would improve outcomes, increase compliance, and reduce disability. When it comes to managing injectables for which long-term efficacy has not yet been established, 85 percent of MCO respondents thought it important to ensure that a patient has failed conventional therapy before receiving an unproven biologic, and 60 percent indicated that patients should be encouraged to initiate biologic therapy with a preferred product within the class (Figure 3). For their part, neurologists emphasized the need for closer communication with insurers about policies regarding reimbursement, FDA-approved and off-label uses, ancillary care, and symptom management — thereby identifying another gap ripe for stakeholder collaboration. The vast majority of neurologists surveyed (95 percent) use infused corticosteroids to treat MS, mostly to treat acute relapse. Although more than 7 in 10 said they seldom or never encounter reimbursement difficulties when prescribing infused corticosteroids, 74 percent have experienced some degree of difficulty in being paid for infused disease-modifying drugs. In addition, 71 percent said their use of such drugs has, at some point, been restricted. As MCOs have adopted such strategies as prior authorization, higher copayments and deductibles, and referrals to specialists in an effort to balance cost and quality, providers indicated that these techniques have repercussions for their patients. Many neurologists believe that these efforts may prevent early diagnosis and treatment of MS, careful management of the disease, and adherence to treatment, although 65 percent did not consider adherence to be a major problem. Patients, too, indicated that they feel the effect of insurer coverage and payment policies. Of the 63 percent of patients in the survey who currently take an immunomodulatory drug, 24 percent mentioned the need for a physician to obtain prior authorization before prescribing, and 8 percent said the drug they were prescribed was denied. Another 30 percent cited such obstacles as insurer discontinuation of coverage, a drug being removed from the formulary, and patients reaching their cap on coverage. These access barriers may suggest that some MCOs do not have a full understanding of the nature MS as a chronic disease, said neurologists who were surveyed. PROMISE FOR COLLABORATION Despite the gaps the report identifies in MS management, all parties surveyed indicate an interest in collaborating on ways to close them. “These groups are reaching out to each other,” confirms LaRocca. “They have received their marching order: Facilitate collaboration while improving quality of care. MS is a complex disease to treat. Support services are critical to managing the disease and to relieving the burden on practitioners.” Kwok believes that “stakeholders 32 BIOTECHNOLOGY HEALTHCARE · SEPTEMBER/OCTOBER 2008

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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