Part D prior authorization and cost sharing rise for MS treatments

If you have multiple sclerosis, effective disease modifying therapies (DMTs), can help to reduce relapse rates and slow disease progression. That is, if you can get access to them. A paper by Hartung et al. (2019) found the following when examining 2007-2016 Prescription Drug Plan Formulary files concerning DMT coverage among Part D plans:

Among therapies available throughout the study period, the rate of prior authorization use increased from 61–66 percent of plans to 84–90 percent. The share of plans with at least one therapy available without limitations declined from 39 percent to 17 percent. The projected cumulative out-of-pocket spending for 2019 was $6,894… Step-therapy edits were used infrequently.

These DMTs are expensive. However, health insurance and having “coverage” for a treatment may mean different things when prior authorization and high cost sharing restricts patient access to these therapies.

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